Pleurodesis with an autologous blood patch to prevent persistent air leaks after lobectomy

Abstract

Management of air leaks after lobectomy with an autologous blood patch is easy, safe, and effective, and does not add costs. It may become the gold standard treatment early in the postoperative course.

Persistent Pleuropulmonary Air Leak Treated with Autologous Blood: Results from a University Hospital and Review of Literature

“…Andreetti et al [18] showed that treating persistent air leak patients for more than 6 days after lobectomy with 100 ml autologous blood was significantly better than treating them with 50 ml, and better than not treating them with blood. Our study did not aim to quantify blood volume used, but apparently the quantity used did not influence our results.…”

Autologous Blood Pleurodesis in Rats to Elucidate the Amounts of Blood Required for Reliable and Reproducible Results

“…Several agents have been described and used for chemical pleurodesis, including tetracycline, talc, silver nitrate, biological glues, polidocanol, with a success rate ranging from 60% to 94%, but none has definitely solved the problem [1][2][3][4][5][6].…”

“…The exact amount of blood that should be injected for reproducible and satisfactory results remains unclear [4,5,[7][8][9][10][11][12][13]. Autologous blood pleurodesis promotes fibrinous pleuritis, leading to pleurodesis as in the natural course of traumatic hemothorax [2].…”

“…Autologous blood pleurodesis is believed to work by multiple methods, including a mechanical action, which is due to a possible ''blood patch effect'' or direct sealing of the leak where immediate cessation of air leak early after instillation is observed and induction of inflammation leading in formation of adhesions where actual pleurodesis occur in a later phase [4,5,9]. We have used autologous blood pleurodesis clinically in the management of spontaneous pneumothorax patients for more than 10 y.…”

“…He reported 85% success rate in his 25 patient series receiving 1 to 3 instillations of 50 mL autologous blood intrapleurally. Other clinical series using autologous blood pleurodesis for spontaneous pneumothorax and/or after pulmonary surgery with success rates ranging from 59% to100% have been reported [4,5,[9][10][11][12][13]. It remains unclear what determined the high variability in the success rate among studies using blood pleurodesis [1,2,12].…”