Respiration; international review of thoracic diseases · 2025
The Utility and Safety of Repeat Talc Administration for Pleurodesis after Immediate and Delayed Pleurodesis Failure.
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Wireko Felix Wadja, Ortiz Jaimes Gabriel E, Kanj Amjad N, Mullon John J, Midthun David E, Schiavo Dante, Anderson Dagny K, Nelson Darlene R, Reisenauer Janani S, Kern Ryan M
Аннотация
INTRODUCTION: Talc pleurodesis is a widely used intervention for recurrent pneumothorax and pleural effusion, particularly in nonsurgical candidates. However, some patients experience immediate failure or recurrence and require additional intervention. The safety and effectiveness of repeated talc administration remain unclear. This study investigated repeat-dose talc pleurodesis to determine its safety and efficacy in the management of initial failures and recurrence.
METHODS: This retrospective study (January 2019-September 2024) analyzed hospitalized patients undergoing talc slurry pleurodesis. Data included demographics, comorbidities, indication, and number of talc doses for successful pleurodesis. The primary outcome was pleurodesis success after repeat dosing. Analyses used chi-square tests, Cox regression for recurrence risk, and Kaplan-Meier estimates for recurrence-free survival.
RESULTS: Among 103 patients who underwent bedside talc slurry pleurodesis for pneumothorax (n = 70) or pleural effusion (n = 33), 80 (77.7%) achieved successful pleurodesis with a single 4 g dose (pneumothorax = 56; effusion = 24). Of the 23 patients with immediate pleurodesis failure, 16 (69.6%) achieved success following repeat-dose pleurodesis (pneumothorax = 7; effusion = 9), while 7 required alternative interventions. Recurrence after discharge occurred in 17 (21.3%) of the single-dose group (pneumothorax = 11; effusion = 6) compared with 1 (6.3%) in the repeat-dose group. Among 18 recurrence cases overall, 9 underwent repeat pleurodesis, with 8 (88.9%) achieving success.
CONCLUSION: Repeat-dose talc pleurodesis may represent a reasonable management approach for patients experiencing immediate failure or recurrence after an initial successful pleurodesis with minimal complications. Further research is needed to optimize protocols and improve outcomes for patients undergoing pleurodesis.
METHODS: This retrospective study (January 2019-September 2024) analyzed hospitalized patients undergoing talc slurry pleurodesis. Data included demographics, comorbidities, indication, and number of talc doses for successful pleurodesis. The primary outcome was pleurodesis success after repeat dosing. Analyses used chi-square tests, Cox regression for recurrence risk, and Kaplan-Meier estimates for recurrence-free survival.
RESULTS: Among 103 patients who underwent bedside talc slurry pleurodesis for pneumothorax (n = 70) or pleural effusion (n = 33), 80 (77.7%) achieved successful pleurodesis with a single 4 g dose (pneumothorax = 56; effusion = 24). Of the 23 patients with immediate pleurodesis failure, 16 (69.6%) achieved success following repeat-dose pleurodesis (pneumothorax = 7; effusion = 9), while 7 required alternative interventions. Recurrence after discharge occurred in 17 (21.3%) of the single-dose group (pneumothorax = 11; effusion = 6) compared with 1 (6.3%) in the repeat-dose group. Among 18 recurrence cases overall, 9 underwent repeat pleurodesis, with 8 (88.9%) achieving success.
CONCLUSION: Repeat-dose talc pleurodesis may represent a reasonable management approach for patients experiencing immediate failure or recurrence after an initial successful pleurodesis with minimal complications. Further research is needed to optimize protocols and improve outcomes for patients undergoing pleurodesis.