At the present time, talc is the agent for pleurodesis that is preferred by the majority of chest physicians in the United States and England. The reason for this preference is that talc, administered either by an aerosol (insufflation) or in a suspension (slurry), is effective, inexpensive, widely available, and associated with minimal side effects in most reports.
Concerns, however, remain about the safety of talc. The primary worry is the observation that ARDS can develop after its intrapleural administration. There are least at 42 cases of ARDS following intrapleural talc administration in the literature, 24 following the use of talc slurry and the remaining 18 following talc insufflation.1–10 In some cases, the patients presented with respiratory failure and required mechanical ventilation. Eleven of the patients died.1,4,6,8–10 The reports of this complication seem to be increasing recently. In one recent article from New Zealand, Brant and Eaton10 reviewed their experience with 33 pleurodesis procedures in 29 patients. They reported that major complications (ie, hypoxemia and hypotension) occurred in seven patients and that two of the patients died.,10– In another recent report, Scalzetti11 reported that 16% of 108 patients undergoing pleurodesis developed a transient interstitial process in the lung ipsilateral to the treated pleural space.