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

Abstract

Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage. Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treatment. Methods: Retrospective study of patients with persistent aerial pleuropulmonary fistula treated with autologous blood. The patient’s own blood was collected from a peripheral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon impeded blood return but not air escape. Results: Between January 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure. Conclusion: Treating persistent pleuropulmonary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness.

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

“…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.…”

“…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.…”

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

“…The volume of blood to be instilled varies in different reports, from 50 mL to 200 mL per instillation (5,(43)(44)(45). The chest drainage tubing is then either clamped or more often elevated relative to the position of the patient and the pleural vacuum drain to allow air to escape while keeping the infused blood inside the pleural space (43,44).…”

“…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.…”

Endobronchial valve placement for the treatment of bronchopleural fistula

“…The most conservative treatment is prolonged chest tube placement with either a pleural drainage system or Heimlich valve. Pleural-based methods include pleurodesis via mechanical, chemical, and autologous means [3][4][5]. These methods of pleurodesis have not been shown to have reliable efficacy, require that the lung has fully re-expanded, and carry with them their own associated risks [6].…”