Is blood pleurodesis effective for determining the cessation of persistent air leak?

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether blood pleurodesis is effective for cessation of persistent air leak (PAL). Altogether more than 43 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that autologous blood pleurodesis has superior outcomes when compared with conservative management for treatment of postoperative PAL. In addition, for PAL causing pneumothorax, blood pleurodesis [optimal volume 100 ml (from two studies)] should be considered in patients who are unsuitable for surgery, talc pleurodesis is ineffective or not viable (including cases complicated by acute respiratory distress syndrome) and a prompt resolution is required. Some 70-81% of patients treated for postoperative air leak resolved within 12 h and 95-100% within 48 h vs. a mean of 3-6.3 days (from two studies) with simple drainage. Resolution of pneumothorax with blood pleurodesis was also significantly shorter (P<0.01). Overall success rates (from all studies) were 92.7% (n=133) from patients having undergone pulmonary surgery (76.6% in one injection, n=111), and 91.7% (n=109) of patients with pneumothorax. Recurrence rates were between 0 and 29% compared with 35-41% for simple drainage, although one controlled study in which the recurrence rate was improved from 16% in controls to 0% in the blood pleurodesis group (at 12-48 months). Minor complication (empyema/fever/pleural effusion) rates varied between studies (0-18%), although they show reduced incidence in line with improving technique over time. A controlled study looking at acute respiratory distress syndrome complicated by pneumothorax showed a significant reduction in mortality (odds ratio 0.6), time to cessation of air leak (P<0.01), weaning time (P<0.01) and intensive treatment unit (ITU) stay (P<0.01) whilst another randomized control study showed significant reduction in hospital stay following pulmonary resection (P<0.001).

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…The recurrence rate after pleurodesis is, however, still considerably higher than following operative treatment of the pneumothorax, so that pleurodesis should be considered especially for patients with contraindication for operative treatment and for patients who refuse surgery. Possible substances for chemical pleurodesis are graduated talc [120], tetracycline [36,120,121,123], povidone-iodine [122] and autologous blood [124]. The substances have been tested in several studies and all attained a reduction in recurrence rate compared to thorax drainage treatment alone.…”

The everlasting issue of prolonged air leaks after lobectomy for non‐small cell lung cancer: A data‐driven prevention planning model in the era of minimally invasive approaches

“…More recently, the European Society of Thoracic Surgery (ESTS) elaborated another risk model for VATS lobectomy, which incorporates three preoperative indicators to provide a readily usable aggregate score . Concurrently, dedicated intraoperative and postoperative strategies have been demonstrated to curb the incidence of PAL . Our objective was to evaluate the impact on PAL of both selected indicators emerging from the aforementioned models as well as other indicators, which have been recognized as predictors of air leaks in other studies.…”

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

“…5 Many subsequent authors have described its use in management of PAL after pulmonary resections and after hydatid cyst operations [6][7][8][9] The success of ABP has been varied in reported literature with success rate as low as 27% and also upto72-100%. [10][11][12] We conducted this study to evaluate the success rate of ABP in a large population of patients with BPF of spontaneous onset. We assessed the success rate of ABP, the number of attempts of ABP required in successful cases and the complications encountered.…”