Pleurodesis is routinely used for the treatment of recurrent malignant pleural effusions. Many agents have been used to produce a pleural symphysis, including silver nitrate (SN), quinacrine, tetracycline and its derivatives doxycycline and minocycline, bleomycin, Corynebacterium parvum, and talc (TL), with different degrees of success. Therapy with SN, which was one of the first agents used to control recurrent pneumothorax, was abandoned apparently because it caused intense pain. The antimalarial agents, particularly quinacrine, are known to induce fever and multiple pleural loculationsA Tetracycline is no longer commercially available and has been replaced mainly by doxycycline, which also causes intense pain. Bleomycin, an antineoplastic agent, was once extensively used, but it is expensive and did not induce pleurodesis in rabbits. C parvum, used mostly in Europe, also was abandoned because its commercial production was stopped. whitening gel
Today, TL is the agent most frequently used for therapy, with a reported success rate of at least 90%. Other advantages of TL include its wide availability, its low cost, and its effectiveness when administered in a minimally invasive procedure (slurry) or by thoracoscopy. Nonetheless, several cases of ARDS have been reported in association with TL pleurodesis. In one study, the insufflation of TL via thoracoscopy in 614 patients with benign and malignant pleural effusions was associated with the development of ARDS in 7 patients (1.2%), which was fatal in 3 patients. Although this is commonly believed to be a rare complication, Rehse and coworkers have reported an incidence of 9% in 89 procedures. Experimentally, the presence of TL particles has been demonstrated in multiple organs after its intrapleural injection in normal rats and rabbits. It is not clear whether acute respiratory failure after TL pleurodesis is related to the TL itself. It is thought that TL may induce a systemic inflammatory response due to several factors, including the systemic absorption of TL or its contaminants. These adverse responses to TL have generated interest in alternative agents for pleurodesis.