Talc pleurodesis is 90-95% effective at prevention of recurrent primary spontaneous pneumothorax. However, there have been reports of ARDS occurring after talc pleurodesis, mostly in patients with malignant pleural effusions, raising concerns over its use.
Bridevaux et al report results of talc pleurodesis on 418 patients with primary spontaneous pneumothorax (PSP) at nine centers in Europe and South Africa, 2002-2008. Most (73%) were young men (mean age 30).
In the 30 days following talc pleurodesis, there were no cases of ARDS, intensive care unit admission, or deaths. The "minor complication" rate was 1.7%. Most patients had around a half-degree elevation in body temperature.
For this indication, authors convincingly argue, talc pleurodesis is safe. (This study was not designed to measure efficacy; perhaps they'll report that separately.)
They used a standard large-particle preparation. Authors postulate that smaller talc particle sizes or interactions with systemic illness could induce more systemic inflammation, and the ARDS seen in other series.
Bridevaux P-O et al. Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study. Eur Resp J 2011;38(4):770-773.