Thoracoscopic talc poudrage in malignant pleural effusions: effective pleurodesis despite low pleural pH

To determine the effectiveness of pleurodesis by thoracoscopic talc poudrage (TTP) in patients with low pH malignant pleural effusions.

Review of prospectively collected data on all thoracoscopic procedures performed from 1982 to 1996.

Twenty-five members in a prepaid, closed-panel health maintenance organization, whose malignant pleural effusion pH was < or = 7.30.

Pleural fluid pH was measured prior to diagnostic and therapeutic, single puncture, rigid thoracoscopy, under local anesthesia, in an operating room.

Success of pleurodesis was determined with serial radiographs at 10 days, 30 days, and frequent intervals until death or up to 1 year following the procedure. Failure was indicated by evidence of recurrent fluid or persistence of a space between the visceral and parietal pleura. Morbidity of the procedure, days of chest tube drainage, and days of hospitalization were recorded concurrently during hospitalization and outpatient follow-up. Fifty of the 76 patients found to have a pleural pH measurement had a pleural pH >7.30, averaging 7.37 (7.31 to 7.55). The other 26 patients (34%) with pH < or = 7.30 (low pH) are the subjects of this study, of whom 25 were evaluable. Pleurodesis was successful in 22 of 25 (88%), although 4 died prior to 30 days. The three failures all had trapped lung. Chest tube drainage averaged 3.2+/-1.3 days, which approximated the time of hospitalization (3.3+/-1.1 days). There were no thoracoscopy-related deaths; significant morbidity occurred only in one patient with trapped lung, who had prolonged chest tube drainage before and after TTP, and eventually developed empyema.

TTP is an effective pleurodesis technique in malignant pleural effusions, even when the pleural pH is low. The short hospital stay and high success rate make this approach a good choice in palliating symptomatic malignant pleural effusions.