Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Abstract

Background: Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. Objective: To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. Methods: This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. Results: In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. Conclusion: ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.

Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances

“…In the absence of large prospective randomised controlled trials, patient selection is difficult, and the concern remains that delaying surgical management increases the risk of pleural infection and the need for more extensive surgical procedures [ 46 ]. Alternative endobronchial therapies have been trialed, such as in a three-armed RCT in China, which included 150 patients with SSPs and a PAL >7 days [ 47 ]. They randomised patients to CTD, localised endobronchial ABP injection with thrombin or an endobronchial silicon spigot bronchial occlusion device.…”

Endobronchial blood-patch: A novel technique for a persistent pleural air leak

“…Persistent air leaks are known to prolong ICU stay and are associated with worse clinical outcomes [ 5 , 6 ]. Endobronchial treatment for persistent air leaks has been described by a number of techniques, using valves, spigots, and a combination of autologous blood with hemostatic synthetic material [ [7] , [8] , [9] , [10] , [11] ]. Autologous blood-patch repair with thrombin has been described only recently [ 4 , 8 , 12 ], and only once at bedside [ 12 ].…”

A Large Central Bronchopleural Fistula Closed by Bronchoscopic Administration of Recombinant Bovine Basic Fibroblast Growth Factor: A Case Report

“…Flexible DOI: 10.1159/000514717 bronchoscopy has evolved from diagnostic to therapeutic modalities in the management of BPF, enabling evaluation of the stump, visualization of the fistula location and size, and the decision of treatment strategy simultaneously. In one of the most extensive series (150 patients), improvement or resolution of BPF occurred in 83% of patients treated bronchoscopically [13]. And a minor BPF without empyema was treated successfully using bronchoscopy with the administration of OK-432, rbFGF, and fibrin glue sealant [27].…”

“…The success rate of BPF closure with surgery has been reported to be over 85% in those patients [4,5]. Various bronchoscopic treatments have been reported for the closure of BPF in small studies, case reports, and expert consensuses, such as adhesive tissue and fibrin glue [6], sclerosing agent [7], one-way endobronchial valve [8,9], ventricular septal defect occluder [10], covered expandable metallic stent [11], endobronchial Watanabe spigot [12,13], and vascular occlusion coil [14]. Although there are no randomized controlled trials to study the efficacy and safety between surgical and bronchoscopic treatment for the closure of postoperative central BPF, the bronchoscopic treatment seems to be a comfortable, safe, well-tolerated, and cost-effective procedure.…”