Predictors of Acute Lung Injury and Severe Hypoxemia in Patients Undergoing Operative Talc Pleurodesis

• Published in: The Annals of thoracic surgery Vol. 82; no. 6; pp. 1976 - 1981
• Main Authors: Kuzniar, Tomasz J., Blum, Matthew G., Kasibowska-Kuzniar, Kamilla, Mutlu, Gökhan M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2006; Elsevier Science
• Subjects: Aged; Antineoplastic Agents; Biological and medical sciences; Edema; Female; Humans; Hypoxia - etiology; Male; Medical sciences; Middle Aged; Oxygen Inhalation Therapy; Pleural Effusion - surgery; Pleurodesis - adverse effects; Pleurodesis - methods; Pneumology; Respiratory Distress Syndrome, Adult - etiology; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Factors; Sclerosing Solutions - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Talc - adverse effects; Thoracic Surgery, Video-Assisted; 14; Human; Lung disease; Oxygen; Talc; Respiratory disease; Predictor; Acute; Prediction; Patient; Thorax; Hypoxemia; Treatment; Surgery; Predictive factor; Severe
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.06.040

Acute lung injury (ALI) is a life-threatening complication of talc pleurodesis. This study defines characteristics that predispose patients to ALI and severe hypoxemia in patients after video-assisted thoracoscopic surgery (VATS) talc pleurodesis.
Charts of patients who underwent talc pleurodesis at Northwestern Memorial Hospital between January 1, 1997 and December 31, 2003 were retrospectively reviewed. We sought variables associated with the development of postoperative ALI or severe hypoxemia, defined as an increase in fraction of the inspired oxygen by more than 0.15 within 24 hours after the surgery. The analysis included 84 patients (58 women, 26 men) who underwent VATS talc pleurodesis for malignant (n = 74) or benign (n = 10) indications.
ALI developed in 5 patients (5.9%), severe hypoxemia developed in 25 (29.8%), and 54 (64.3%) did not have postoperative complications. In multivariate analysis, the presence of peripheral edema before pleurodesis (
p = 0.005), any preoperative requirement for supplemental oxygen (
p = 0.032), and chemotherapy within 14 days before pleurodesis (
p = 0.04) were identified as predictors of ALI or severe postoperative hypoxemia.
Oxygen supplementation, recent chemotherapy, and presence of peripheral edema were independent predictors of a combined outcome of ALI or severe hypoxemia after VATS talc pleurodesis. Patients with these characteristics might be at risk for adverse outcomes of talc pleurodesis and should be considered for alternative therapy for their effusions.