The efficacy and economical benefits of blood patch pleurodesis in secondary spontaneous pneumothorax patients

Abstract

IntroductionProlonged air leak in secondary spontaneous pneumothorax (SSP) patients remains one of the biggest challenges for thoracic surgeons. This study investigates the feasibility, effectiveness, clinical outcomes, and economical benefits of the autologous blood patch pleurodesis method in SSP.Material and methodsFirst-episode SSP patients undergoing autologous blood patch pleurodesis for resistant air leak following underwater-seal thoracostomy, between January 2010 and June 2013 were taken into the study. Timing and success rate of pleurodesis, recurrence, additional intervention, hospital length of stay, and complications that occurred during follow-up were examined from medical records, retrospectively.ResultsThirty-one (27 male, 4 female) SSP patients with expanded lungs on chest X-ray and resistant air leak on the 3rd post-interventional day were enrolled. Mean age was 53.7 ± 18.9 years (range: 23-81). Twenty-four patients were treated with tube thoracostomy, 2 with pezzer drain, and 5 with 8 F pleural catheter. 96.8% success was achieved; air leak in 29 of 31 patients (93.5%) ceased within the first 24 hours. No procedure-related complication such as fever, pain or empyema was seen. Late pneumothorax recurrence occurred in 4 (12.9%) patients; 1 treated with talc pleurodesis where the other 3 necessitated surgical intervention.ConclusionsAutologous blood patch pleurodesis is a safe, effective, and easily performed procedure with no need of any additional equipment or extra cost. This method can be applied to all patients with radiologically expanded lungs and continuous air leak after 48 hours following water-seal drainage thoracostomy, to reduce hospital stay duration, unnecessary surgical interventions, and the expenses.

Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

“…As noted in the ‘Talc’ section above, a small retrospective comparison study of talc via chest drain versus blood patch was inconclusive. 39 Two further small retrospective series of patients unfit for surgery with recurrence or persistent air leak found long-term recurrence of 16.0% 49 and 16.1% 50 with no comparator groups.…”

Spontaneous pneumothorax in diffuse cystic lung diseases

“…Blood patch pleurodesis, whereby a patients own blood is instilled through an existing chest tube, has emerged as an effective option for treatment for pneumothorax with reported pneumothorax recurrence rates of 15.6–18.2% (99). The advantage of this technique is the almost complete absence of typical pleurodesis-associated side effects such as pain and fever (100). The introduction of blood in an otherwise sterile cavity may, however, lead to an increased risk of infectious complications.…”

Experience of Pleurodesis with a 50% Glucose Solution in Patients with Secondary Pneumothorax: A Case Series

“…Instillation of chemical agents, doxycycline, and talc has been recommended in cases of prolonged air leakage. [3] Pleurodesis is an easy, safe, effective, and well-tolerated treatment for secondary pneumothorax [6,7,9,11] Some studies have reported the effectiveness of pleurodesis using a 50% glucose solution in treating pneumothorax with prolonged air leakage after a surgical procedure or chylothorax [12,14,15]. To my knowledge, only a few studies have investigated patients with secondary pneumothorax in whom surgery is contraindicated [13].…”

“…Pleurodesis for malignant pleurisy and pneumothorax with prolonged air leakage is simple, effective, and safe [6][7][8][9][10]. OK-432, autoblood, and minocycline are often used in pleurodesis for refractory pneumothorax [6,7,9,11].…”

“…OK-432, autoblood, and minocycline are often used in pleurodesis for refractory pneumothorax [6,7,9,11].…”