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Umar Z, Nassar M, Ashfaq S, Foster A, Sandhu JK, Ariyaratnam J, Lopez R, Trandafirescu T. The Efficacy and Safety of Autologous Blood Patch for Persistent Air Leaks: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e36466. [PMID: 37090364 PMCID: PMC10115736 DOI: 10.7759/cureus.36466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 04/25/2023] Open
Abstract
Persistent air leaks (PALs) are associated with prolonged hospital stays, contamination and sustained infection of the pleural space, and significant morbidity. A fistulous tract between the alveoli and the pleural space is referred to as an alveolar-pleural fistula (APF), whereas a fistulous tract between the bronchiole and the pleural space is referred to as a bronchopleural fistula (BPF). There is no consensus on the treatment, and multiple modalities exist for the management of persistent air leak (PAL). Autologous blood patch (ABP) is a relatively safe and inexpensive method that has been used for many years for the treatment of PALs. We conducted an electronic database search between 08/24/2022 and 08/27/2022 in PubMed, Embase, and Cochrane using keywords. The following keywords were used: "Blood patch" OR "Autologous blood patch" AND "pleurodesis." Our study included all original studies with the prime focus on the etiology of PALs, clinical characteristics, procedural details of ABP, and outcomes of the proposed treatment. The primary outcomes that were the focus of our study were the time to seal the air leak, the time to remove the chest tube after air leak cessation, and the time to discharge from the hospital. To determine the safety of ABP, we also evaluated the procedural outcomes. Our findings suggest a statistically significant decrease in the time to air leak cessation when compared to the control group (mean difference of -3.75 {95% CI: -5.65 to -1.85; P=0.001}) with considerable heterogeneity of I2=85% and P=0.001. However, the difference was not statistically significant when a lower dose of ABP (50 mL) was compared to a higher dose (100 mL) (mean difference of 1.48 {95% CI: -0.07 to 3.02; P=0.06}) and considerable heterogeneity of I2=80% and P=0.03. There was no statistically significant difference in the time to discharge when compared to the control group (mean difference of -2.12 {95% CI: -4.83 to 0.59; P=0.13}) and considerable heterogeneity (I2=95% and P<0.001). When compared to the control group, ABP did not provide any statistically significant difference in the risk ratio for infection (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), pain (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), and fever (0.54 {95% CI: 0.27 to 1.10; P=0.09} and no heterogeneity {I2=0% and P=0.50}). Our study concludes that using ABP caused a statistically significant decrease in the time to air leak cessation when compared to the control group. However, the procedure does not provide a statistically significant difference in the time to discharge from the hospital when compared to conservative treatment. Similarly, there was no statistically significant difference in the risk ratio for complications such as infection, pain, and fever when compared to conservative management. More studies need to be conducted to fully understand the efficacy and safety of ABP in the management of PALs.
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Affiliation(s)
- Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Allison Foster
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Jasmine K Sandhu
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | | | - Ricardo Lopez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Huseynov M, Hakalmaz AE. Neonatal pneumothorax from the perspective of a pediatric surgeon: classification and management protocol: a preliminary algorithm. Turk J Med Sci 2021; 51:1201-1210. [PMID: 33433972 PMCID: PMC8283476 DOI: 10.3906/sag-2010-286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/12/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Current neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences. Material and methods The records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. The patients with pneumothorax were identified through the neonatology department patient database search. The study only included the patients with symptomatic pneumothorax and these patients were evaluated into 3 groups based on the changes in peripheral oxygen saturation (SpO2) and clinical features immediately after the tube thoracostomy (TT) procedure. Accordingly, neonatal pneumothorax was divided into 3 types: patients with SpO2 increasing immediately after TT were included in type I, patients whose SpO2 did not change after TT were included in type II, and patients with SpO2 decreasing immediately after TT were included in type III pneumothorax. Results A total of 82 patients were included in the study. Sixty-one percent of these patients had type I, 24% had type II, and 15% had type III pneumothorax. None of the neonates died in type I and II pneumothoraces while 9 of 12 neonates (75%) died within the neonatal period in type III pneumothorax. Although we applied treatments such as high-frequency oscillatory ventilation, selective intubation, continuous negative aspiration, and surgical treatment to our patients that were lost due to type III pneumothorax, we were not successful. We successfully managed our surviving type III pneumothorax patients with a simple pressure cycle ventilator, using a combination of high rates, modest peak airway pressures [18 to 22 cm H2O and no positive end-expiratory pressure (PEEP)], and an autologous blood patch. Conclusion Classification of pneumothoraces into different types significantly contributes to patient treatment planning through a predetermined strategy, not through trial-and-error. High frequency and zero PEEP ventilation can provide significant improvement in risky cases.
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Affiliation(s)
- Mirzaman Huseynov
- Department of Pediatric Surgery, Private Safa Hospital, İstanbul, Turkey,Department of Pediatric Surgery, Private Avicenna Hospital, İstanbul, Turkey
| | - Ali Ekber Hakalmaz
- Department of Pediatric Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Pruitt LCC, Kastenberg ZJ, Fenton SJ, Short SS. Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks. J Pediatr Surg 2021; 56:629-631. [PMID: 33189301 DOI: 10.1016/j.jpedsurg.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Experience with autologous blood patch (ABP) pleurodesis for persistent air leak in the pediatric population is limited. The purpose of this series was to describe the experience with ABP at a single tertiary children's hospital. METHODS A retrospective study was performed of all thoracic procedures done by the pediatric surgery service over three years. RESULTS Ten patients underwent a total of 17 ABPs. The median age of patients was 12 years (IQR 6-16). The most common underlying reasons for a thoracic procedure included: blebectomy for spontaneous pneumothorax (2), need for lung biopsy (2), resection of known malignant tumor (2), and empyema (2). The median number of days of persistent air leak before first ABP was 7.5 days (IQR 7-10). A second ABP was performed in 6 cases with a third procedure performed in one case. None of the patients developed respiratory compromise during ABP and no infectious complications were identified following ABP. CONCLUSIONS Our cohort demonstrates that ABP for persistent air leak following thoracic surgery is effective with minimal morbidity in children. We believe ABP can be used early and in patients with a broad range of underlying lung pathology.
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Affiliation(s)
- Liese C C Pruitt
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA.
| | - Zachary J Kastenberg
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
| | - Stephen J Fenton
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
| | - Scott S Short
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
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A first case report of neonatal persistent pneumothorax treated with an autologous blood patch. Turk Arch Pediatr 2020; 55:438-440. [PMID: 33414664 PMCID: PMC7750350 DOI: 10.14744/turkpediatriars.2019.68235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
Pneumothorax is the most common type of air leak. Although the majority of pneumothoraces resolves spontaneously, some continue several days after the lung injury. Autologous blood patch pleurodesis is the most commonly used technique in the treatment of persistent pneumothorax. The use of an autologous blood patch in persistent pneumothorax in neonates has not been reported before. We report the first case of newborn persistent pneumothorax successfully treated with an autologous blood patch. The patient was a newborn aged 2 days. He was admitted to the neonatal intensive care unit due to subcostal-intercostal retractions after birth. Chest X-ray was performed and pneumothorax was detected on the right side. Persistence of the air leak led to treatment with an autologous blood patch on day 17 of pneumothorax development. Pleurodesis was repeated on days 3 and 6 of the first autologous blood patch, respectively. Air leak sealed within 2 days after the third autologous blood patch. In our opinion, this procedure is safe and effective when performed with the correct technique, and can also be used safely in newborns.
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Bersenas AM, Hoddinott KL. Allogenic blood patch pleurodesis for continuous pneumothorax in three cats. JFMS Open Rep 2020; 6:2055116920945595. [PMID: 32944268 PMCID: PMC7466898 DOI: 10.1177/2055116920945595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Case series summary Following diaphragmatic herniorrhaphy, three cats developed a continuous pneumothorax. All three cats required continuous suction to evacuate air from the thoracic cavity. Despite continuous suction, the pneumothorax persisted for all cats and blood patch pleurodesis (BPP) was performed using blood donor cats. All three cats had resolution of their pneumothorax within 24 h of BPP. Relevance and novel information This is the first report of BPP used in feline patients. More recently autologous BPP has been reported for use in dogs and humans, with a reportedly high success rate. BPP may allow timely resolution of continuous pneumothorax in cats and provide an alternative treatment option to prolonged medical management or surgical intervention. Allogenic blood from a donor cat may be necessitated in feline BPP when cardiovascular instability is appreciated in these small patients.
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Affiliation(s)
- Alexa M Bersenas
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Katie L Hoddinott
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Canada
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Botwin AL, Niedzwiecki GA, Botwin KP. Persistent air leak treated by autologous blood patch pleurodesis: the role of CT-guided small-bore chest tube insertion. Clin Imaging 2020; 60:75-78. [DOI: 10.1016/j.clinimag.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022]
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Stamenovic D, Messerschmidt A, Steger V, Schneider T. New method in treatment of post-operative air leakage with fresh frozen plasma. ANZ J Surg 2019; 90:144-149. [PMID: 31566304 DOI: 10.1111/ans.15451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/04/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND No consensus regarding the best post-operative treatment option for air leak has been established. In this study, we evaluate the use of intra-pleural fresh frozen plasma (FFP) as a promising treatment method. METHODS Treatment for a sustained air leak (3 days) was warranted in approximately 12% of the lung surgeries at our institution. Fifty-two patients were treated with FFP by application of 250 mL daily. The patients were divided into two cohorts: cohort 1 consisted of 35 patients undergoing anatomical lung resections and cohort 2 consisted of 17 patients after miscellaneous types of lung surgery. Successfulness of the procedure as well as the potential influential factors was evaluated statistically and validated by a bootstrapping. Area under receiver operating characteristic curve was used to establish a cut-off value of the predictor. RESULTS In the first cohort, air leakage was successfully treated in 28 (80%), while in seven (20%) it was still present after third treatment with FFP. The success rate in cohort 2 was 76.5%. The only covariate which appeared to remain significant in both cohorts was flow as displayed on the digital suction device prior to application of FFP. Flow ≤375 mL/min was indicative of successful aerostasis. CONCLUSION Intra-pleural instillation of FFP seems to be a feasible method for the treatment of post-operative air leakage. Although the optimum strategy regarding its application as well as its limitations is yet to be established, an absence of complications or undesirable events makes this (off label) method a safe and promising alternative to existing options.
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Affiliation(s)
- Davor Stamenovic
- Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
| | - Antje Messerschmidt
- Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
| | - Volker Steger
- Thoracic Surgery Department, Clinic of Thoracic, Cardiac and Vascular Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Thomas Schneider
- Department of Thoracic Surgery, ViDia Kliniken Karlsruhe, Karlsruhe, Germany
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Ma V, Dhatt R, Haddock C, Skarsgard ED, Heran MK. Treatment of recurrent or persistent spontaneous pneumothorax in children with synthetic glue pleurodesis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pathak V, Quinn C, Zhou C, Wadie G. Use of autologous blood patch for prolonged air leak in spontaneous pneumothoraces in the adolescent population. Lung India 2018; 35:328-331. [PMID: 29970773 PMCID: PMC6034386 DOI: 10.4103/lungindia.lungindia_462_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Instillation of an autologous blood patch for prolonged air leak (PAL) in chest tube system has been studied and determined to be a safe and effective treatment plan for adults. The current recommended treatment guidelines for a PAL in adolescent secondary to a spontaneous pneumothorax are surgical intervention. This paper serves as documentation of two case reports with successful treatment of PALs with autologous blood patch in two adolescent patients.
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Affiliation(s)
- Vikas Pathak
- Department of Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington; Department of Pulmonary and Critical Care, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Caitlin Quinn
- Department of Pulmonary and Critical Care, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Christine Zhou
- Department of Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - George Wadie
- Department of Pulmonary and Critical Care; Department of Pediatric Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
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Garnon J, Cazzato RL, Koch G, Uri IF, Tsoumakidou G, Caudrelier J, Tricard T, Gangi A, Lang H. Trans-rectal Ultrasound-Guided Autologous Blood Injection in the Interprostatorectal Space Prior to Percutaneous MRI-Guided Cryoablation of the Prostate. Cardiovasc Intervent Radiol 2017; 41:653-659. [PMID: 29230498 DOI: 10.1007/s00270-017-1853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a novel technique of ultrasound-guided injection of autologous blood in the interprostatorectal space, in an attempt to facilitate ablative prostatic procedures by widening durably the space between the rectum and the prostate. MATERIALS AND METHODS Between April and November 2016, four consecutive patients underwent the haemoprotection injection technique. For each patient, we recorded the time to perform the technique, the amount of injected blood, the achieved distances between the rectum and the prostate post-injection at fixed defined points (apex, middle, and base of prostate at the midline, left, and right sides of the gland), the extension of the ice ball outside the prostate capsule at those fixed points, and whether any residual blood was present on 1-month follow-up MRI. RESULTS Mean time to perform haemoprotection injection was 54 min, with an average blood volume of 103 cc. Mean distance achieved at the apex, middle, and base of the prostate, respectively, was 12, 13, and 16 mm in the midline; 8, 10, and 13 mm on the left side; and 9, 10, and 13 mm on the right side. The mean extension distance of the ice ball beyond the capsule was 4, 6, and 6 mm in the midline; 4, 5, and 6 mm on the left side; and 1, 3, and 3 mm on the right side. No residual blood was present on 1-month follow-up MRI in all patients. No rectal fistula occurred. CONCLUSION Haemoprotection may create a safe and effective virtual space between the prostate and rectum.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Ishaq Fahmi Uri
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
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Autologous “blood patch” pleurodesis: A safe and useful treatment for persistent pneumothorax in children. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Navarro Mingorance A, Pastor Vivero MD, León León MC, Reyes Domínguez SB, Fuster Soler JL. [Autologous «blood patch» pleurodesis: A safe and useful treatment for persistent pneumothorax in children]. An Pediatr (Barc) 2015; 85:157-8. [PMID: 26748874 DOI: 10.1016/j.anpedi.2015.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Alvaro Navarro Mingorance
- Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | | | - Maria Cruz León León
- Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Jose Luis Fuster Soler
- Unidad de Oncohematología Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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