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Ann Thorac Surg 2006;82:1976-1981
© 2006 The Society of Thoracic Surgeons
a Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
b Division of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
c Department of Pulmonary Medicine, Wroclaw Medical University, Wroclaw, Poland
Accepted for publication June 19, 2006.
* Address correspondence to Dr Kuzniar, Sleep Disorders Center, Mayo Clinic, 200 First St SW, Rochester, MN 55902 (Email: kuzniar.tomasz{at}mayo.edu).
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
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