Talc pleurodesis and acute respiratory distress syndrome

Talc is the only agent shown to be effective in patients with low pleural pH (associated with shorter survival after pleurodesis than normal pH).1 However, its superiority to other sclerosants in randomised studies2 has been tempered by reports in the Americas of patients developing acute respiratory distress syndrome (ARDS) after talc application. Three prospective studies have all favoured poudrage over slurry,11-13 although statistical significance was achieved only in two of the three studies, in patients with lung cancer and breast cancer.11 82% of patients had successful pleurodesis with poudrage versus 67% success with slurry.