Serious complications with talc slurry pleurodesis

Talc is a highly efficacious and commonly employed agent for chemical pleurodesis, which has generally been felt to be well tolerated. However, increasing reports of adult respiratory distress syndrome (ARDS) have heightened safety concerns. A recent case of ARDS prompted us to review our experience with talc pleurodesis.

We conducted a retrospective review of all patients who received talc slurry pleurodesis at Green Lane Hospital, Auckland, New Zealand, between 1 January 1998 and 31 December 1999 and documented all complications occurring within 48 h of the procedure.

Thirty-three talc pleurodesis were performed on 29 patients, most commonly for a malignant pleural effusion. Complications occurred in 15 patients (52% of procedures). Minor complications included tachycardia (n = 11; 33%), pain (n = 9; 27%), fever (n = 8; 24%) and dyspnoea (n = 4; 12%). Major complications occurred in seven patients with hypoxaemia and hypotension. Two of these patients died; one death directly attributable to ARDS, the other hastened by a talc pleurodesis-related tachycardia.

These results challenge the assumption that talc pleurodesis is a safe procedure. There were a significant number of serious complications, including a death, from ARDS. Physicians and patients should be aware that complications occur frequently after talc pleurodesis which may be life-threatening or fatal.