Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc

Abstract

Background and objective: Talc pleurodesis is commonly performed to manage refractory pleural effusion or pneumothorax. It is considered as a safe procedure as long as a limited amount of large particle size talc is used. However, acute respiratory distress syndrome (ARDS) is a rare but serious complication after talc pleurodesis. We sought to determine the risk factors for the development of ARDS after pleurodesis using a limited amount of large particle size talc. Methods: We retrospectively reviewed patients who underwent pleurodesis with talc or OK-432 at the University of Tokyo Hospital. Results: Twenty-seven and 35 patients underwent chemical pleurodesis using large particle size talc (4 g or less) or OK-432, respectively. Four of 27 (15%) patients developed ARDS after talc pleurodesis. Patients who developed ARDS were significantly older than those who did not (median 80 vs 66 years, P = 0.02) and had a higher prevalence of underlying interstitial abnormalities on chest computed tomography (CT; 2/4 vs 1/23, P < 0.05). No patient developed ARDS after pleurodesis with OK-432. This is the first case series of ARDS after pleurodesis using a limited amount of large particle size talc. Conclusion: Older age and underlying interstitial abnormalities on chest CT seem to be risk factors for developing ARDS after talc pleurodesis.

Anaphylactic Shock Caused by Talc Pleurodesis Performed for Postoperative Air Leakage

“…6 However, complications have been reported, including ARDS and death. 2,3 In addition, old age and underlying interstitial abnormalities are known risk factors. 3 Beginning in March 2019 in Japan, package inserts for Unitalc began listing anaphylactic shock as an infrequent side effect.…”

“…2,3 In addition, old age and underlying interstitial abnormalities are known risk factors. 3 Beginning in March 2019 in Japan, package inserts for Unitalc began listing anaphylactic shock as an infrequent side effect. Two cases were reported in which possible anaphylactic reactions to talc administration could not be ruled out.…”

“…T alc pleurodesis is commonly used worldwide to prevent malignant pleural effusions and pneumothorax. [1][2][3] It is considered a safe procedure, but it has occasionally been reported to result in conditions associated with respiratory failure, such as acute respiratory distress syndrome (ARDS) and acute pneumonitis. 2,3 Here we report a case of talc pleurodesis-induced anaphylactic shock in a patient being treated for postoperative air leakage.…”

Contemporary Concise Review 2018: Lung cancer and pleural disease

“…The frequency of post‐pleurodesis ARDS varies from series to series, ranging from 0% to 9% . The study by Shinno et al . sought to determine risk factors that may predispose to this complication.…”

Medical Thoracoscopy-Assisted Argon Plasma Coagulation Combined with Electrosurgical Unit for the Treatment of Refractory Pneumothorax in Elderly Patients

“…However, old age and underlying interstitial disorders are confirmed risk factors and lead to a poor prognosis for elderly patients with refractory pneumothorax, complications include acute respiratory disease syndrome (ARDS) or even death. 10) In addition, inflammatory reactions induced by the pleurodesis procedure confer a potential risk for elderly patients with possible imbalanced inflammation homeostasis. 11)…”