Early Pleurodesis for Postoperative Air Leak with Autologous Blood and 50% Glucose Solution

Abstract

Background: Postoperative air leaks after pulmonary resection prolong the duration of chest drainage and the length of hospital stay. One of the many treatment options is bedside pleurodesis using various agents. This study evaluated the feasibility of an early intervention to stop postoperative air leaks with either autologous blood or a 50% glucose solution. Methods: We retrospectively reviewed 323 patients who underwent bedside pleurodesis between January 2017 and March 2022. Sixty-four patients received autologous blood patch pleurodesis, and 36 were treated with a 50% glucose solution after pulmonary resection. The primary endpoints were the total postoperative tube indwelling time, post-pleurodesis tube indwelling time, and hospital stay. A propensity score-matched analysis was performed. Results: In the autologous blood patch pleurodesis and 50% glucose solution groups, the mean initiation timing of postoperative pleurodesis were 2.06±1.62 and 3.28±1.56 days, the mean duration of the tube indwelling time after surgery was 6.58±3.02 and 6.42±4.92 days, and the mean duration of the tube indwelling time after pleurodesis, it was 4.53±3.10 and 3.11±4.80 days, respectively. In addition, the total length of hospital stay was 9.11±5.42 and 7.83±4.75 days in the autologous blood patch pleurodesis and 50% glucose solution groups, respectively. Conclusion: Early postoperative air leak cessation with autologous blood patch pleurodesis or 50% glucose solution pleurodesis is a feasible procedure with acceptable outcomes that effectively shortens the hospital stay.

Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis

“…In many cases, surgical intervention may not be safe or feasible based on a patient's comorbid conditions, age, clinical status, or preferences [15]. ABPP has been reported to have beneficial outcomes when attempted two to 3 days after chest tube placement, including less time to pleural effusion drainage, chest tube removal, and shortened hospital stays [16,17]. Case 1 was the first application of ABPP in TB at our institution and proved to be successful 3 months after initial presentation.…”

Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies

“…Pleurodesis using glucose solutions represents a less commonly employed but effective method for managing recurrent pleural effusions and postoperative air leaks. This technique involves instilling hypertonic glucose solutions into the pleural cavity, which works by inducing an osmotic gradient that promotes fluid reabsorption and leads to pleural irritation [71]. The resulting inflammatory response encourages the fusion of the visceral and parietal pleura.…”

“…The resulting inflammatory response encourages the fusion of the visceral and parietal pleura. While this method is advantageous for its simplicity, low cost and the low risk of adverse reactions associated with glucose, its application is carefully considered against other sclerosing agents, depending on the patient's specific condition and overall treatment goals [71,72].…”

Commentary: Early Bedside Pleurodesis for Postoperative Air Leak: Proper Indications and Agents?

“…In this retrospective study, the authors evaluated the effectiveness of bedside pleurodesis with either autologous blood or 50% glucose solution in the early period after lung resection surgery at a single center [1]. The study included 64 patients in the blood group and 36 patients in the glucose group over a period of approximately 5 years.…”