Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

Abstract

ObjectiveThe aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax.Patients and methodsA number of 15 patients (10 male and 5 female) were included in this prospective study between March 2005 and December 2009. The duration of the air leak exceeded 7 days in all patients. The application of blood pleurodesis was used as the last preoperative conservative method of treatment in 12 patients. One patient refused surgery and two were ineligible for operation due to their comorbidities. A blood sample of 50 ml was obtained from the patient's femoral vein and immediately introduced into the chest tube.ResultsA success rate of 27% was observed having the air leak sealed in 4 patients in less than 24 hours.ConclusionDespite our disappointingly poor outcome, the authors believe that the procedure's safety, convenience and low cost establish it as a worth trying method of conservative treatment for patients with the aforementioned pathology for whom no other alternative than surgery would be a choice.

Autologous blood patching in the management of broncho-pleural fistula in spontaneous pneumothorax

“…Success was achieved in the second attempt in 21% (12/55) and third attempt in 25% (11/43). This result not only closely resembles that of some previous reports 13,18 but also implies that more than one attempt at ABP would hold a reasonable chance of success. This would hold special importance in patients who are poor surgical risk.…”

“…Therefore, the true success rate of this procedure would be difficult to decipher based solely on small scale studies. The review by Chambers et al 13 has shown very high success figures. However, it is faulted by the non-inclusion of some recent papers which have reported very modest results.…”

“…10 The success of ABP in our series is considerably lower than in many reported series. 5,13,14 It is possible to explain when we look more closely to the specific aspects of our methodology and the nature of previous reports. Almost all previous reports are severely limited by their small sample size.…”

“…Most other series have reported using ABP between five and nine days after conservative treatment. [13][14][15] Although some authors have waited up to five weeks 6 before applying ABP, it is intuitive that the longer the chest drain has been in-situ, the greater the likelihood of colonization of the chest tube with bacteria. This could potentially exacerbate chances of infection in the pleural space when performing ABP.…”

Persistent air leaks: a review with an emphasis on bronchoscopic management

“…Dumire and colleagues reported successful use of blood pleurodesis in both a postoperative PAL and a PAL secondary to spontaneous pneumothorax (5). Other authors report rates of success ranging from 27% to 85% (43,44,46). Interestingly, Cao and colleagues randomized 44 patients with PAL from spontaneous pneumothorax to receive intrapleural instillation of 1 mL/kg normal saline placebo or 3 different doses or volumes of autologous blood for pleurodesis.…”