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Glatt J, Chandar P. The future of chemical pleurodesis: A review of novel and investigational sclerosant agents. Am J Med Sci 2024; 368:175-181. [PMID: 38670530 DOI: 10.1016/j.amjms.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Chemical pleurodesis is a technique in which an injurious and inflammatory substance is instilled into the pleural cavity to cause adhesion and fibrosis. It is commonly used in the management of recurrent malignant pleural effusions. Historically, many different types of sclerosants have been described, though only a few, including talc, the tetracycline derivatives, and anti-septic compounds such as silver nitrate and iodopovidone, have found their way into mainstream use. However, over the past several years, there has been increasing interest in alternative pleurodesis agents. In this review, we will explore future directions in the field, with an eye toward novel and investigational agents.
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Affiliation(s)
- Jonathan Glatt
- Thomas Jefferson University Hospital, Department of Pulmonary, Allergy, and Critical Care Medicine, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA.
| | - Prarthna Chandar
- Thomas Jefferson University Hospital, Department of Pulmonary, Allergy, and Critical Care Medicine, 834 Walnut Street, Suite 650, Philadelphia, PA 19107, USA
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2
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Duron G, Backer E, Feller-Kopman D. Evaluation and management of persistent air leak. Expert Rev Respir Med 2023; 17:865-872. [PMID: 37855445 DOI: 10.1080/17476348.2023.2272701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Persistent air leaks (PAL) represent a challenging clinical problem for which there is not a clear consensus to guide optimal management. PAL is associated with significant morbidity, mortality, and increased length of hospital stay. There are a variety of surgical and non-surgical management options available. AREAS COVERED This narrative review describes the current evidence for PAL management including surgical approach, autologous blood patch pleurodesis, chemical pleurodesis, endobronchial valves, and one-way valves. Additionally, emerging topics such as drainage-dependent air leak and intensive care unit management are described. EXPERT OPINION There has been considerable progress in understanding the pathophysiology of PAL and growing evidence to support the various non-surgical treatment modalities. Increased recognition of drainage-dependent persistent air leaks offers the opportunity to decrease the number of patients requiring additional invasive treatment. Randomized control trials are needed to guide optimal management.
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Affiliation(s)
- Garret Duron
- Department of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elliot Backer
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
| | - David Feller-Kopman
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
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Barton EC, Maskell NA, Walker SP. Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions. Semin Respir Crit Care Med 2023. [PMID: 37321247 DOI: 10.1055/s-0043-1769615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.
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Affiliation(s)
- Eleanor C Barton
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Nick A Maskell
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Steven P Walker
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
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Autologous Blood Patch Pleurodesis for Secondary Spontaneous Pneumothorax: A Narrative Review, a Retrospective Case Series and State of Play in the UK. Pulm Ther 2022; 9:165-172. [PMID: 36585556 PMCID: PMC9931973 DOI: 10.1007/s41030-022-00212-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Treatment of prolonged air leak due to secondary spontaneous pneumothorax is challenging. Autologous blood patch pleurodesis (ABPP) is a treatment option. Previous evidence is reliant on single-centre series and underpowered trials and is mostly described in air leaks post cardiothoracic intervention. There are no United Kingdom (UK) wide data. METHODS Members of the UK Pleural Society were surveyed for their practice and for patients who underwent blood patch. There were 16 respondents from 333 members. Twelve had performed the procedure, and six had kept records and could submit data. Basic demographics, intervention and clinical details of patients were then collected. The study was sponsored by the Audit Department of Northumbria Healthcare NHS Foundation Trust (reference 8124), and Caldicott Clearance for data sharing was provided by the Trust's Information Goverance Board (reference C4221). There was no requirement for informed consent. RESULTS Data for 12 patients that received ABPP between 2014 and 2022 in six respiratory centres were assessed. The aetiology of the secondary pneumothoraces was mostly due to chronic obstructive pulmonary disease and end-stage interstitial lung disease. The patients had a median age of 75 years. The median air leak time before ABPP was 17 days. A total of 50-100 ml of blood was used for ABPP. Five patients had two attempts at ABPP. Air leak resolved in six patients (50%). Four patients had pleural apposition prior to ABPP. Four patients were diagnosed with hospital-acquired pneumonia following ABPP. CONCLUSION This is the only UK-wide retrospective case series of ABPP of 'medical' patients with secondary pneumothorax. There is widespread variation in care. No formal conclusions can be drawn, and much larger robust datasets are required. An application has been made to the European Respiratory Society to incorporate ABPP within the International Collaborative Effusion database.
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Campisi A, Dell'Amore A, Zhang Y, Gu Z, Ciarrocchi AP, Faccioli E, Bertolaccini L, Rea F, Stella F, Fang W. Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood? Thorac Cardiovasc Surg 2022; 70:671-676. [PMID: 33851409 DOI: 10.1055/s-0041-1727129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. METHODS We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. RESULTS After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1-13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. CONCLUSION In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.
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Affiliation(s)
- Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Thoracic Diseases, Thoracic Surgery Unit, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Andrea Dell'Amore
- Department of Cardiothoracic Surgery and Vascular Sciences, Division of Thoracic Surgery, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Angelo Paolo Ciarrocchi
- Department of Thoracic Diseases, Thoracic Surgery Unit, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Eleonora Faccioli
- Department of Cardiothoracic Surgery and Vascular Sciences, Division of Thoracic Surgery, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Federico Rea
- Department of Cardiothoracic Surgery and Vascular Sciences, Division of Thoracic Surgery, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Franco Stella
- Department of Thoracic Diseases, Thoracic Surgery Unit, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Narenchandra V, Vishnukanth G, Dwivedi DP, Hemachandren M, Adithian S, Vinod Kumar S, Rajangam M, Mohapatra MM, Upadhya P. Comparison of efficacy of autologous blood patch pleurodesis versus doxycycline pleurodesis in the management of persistent air leak in patients with secondary spontaneous pneumothorax. A randomized control trial. Monaldi Arch Chest Dis 2022. [PMID: 35698824 DOI: 10.4081/monaldi.2022.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) patients sometimes have a persistent air leak (PAL) that leads to increased morbidity and increased hospital stay. Further, these patients also need pleurodesis to prevent a recurrence. Autologous blood patch pleurodesis (ABPP) has been successfully tried in post lobectomy air leak cases. However, its utility in SSP patients with PAL has not been widely established. In this context, we performed a non-blinded randomized control study to compare the efficacy of ABPP vs doxycycline pleurodesis in the closure of air leak in SSP patients. This study was a non-blinded randomized control study done in 38 SSP patients with PAL. They were randomized into doxycycline arm and ABPP arm. Post pleurodesis air leak was assessed every 12 hours for cessation. Success was considered when there was a complete cessation of air leak. Post-procedural complications were noted and patients were followed up for 28 days to look for recurrence. The median time for closure was 24 hours [interquartile range (12.24)] for ABPP and 36 hours [interquartile range (24.72)] for doxycycline pleurodesis. Success rate of ABPP vs doxycycline pleurodesis is 94.7% vs 84.2% (p=0.6). Post-procedure pain was more in doxycycline group (15% vs 73%) (p<0.01). On visual analogue scale, ABPP had a lesser pain as compared to doxycycline pleurodesis (average visual analogue scale value of 2 vs scale of 7). The recurrence rate was equal in both groups (5%). Though ABPP and doxycycline have similar success rates, ABPP has an early closure of air leak and greater patient tolerability. ABPP can be tried as an alternative to doxycycline pleurodesis in SSP patients with persistent air leaks.
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Affiliation(s)
- Vijayarangam Narenchandra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Govindaraj Vishnukanth
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Munuswamy Hemachandren
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Subathra Adithian
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Saka Vinod Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Manju Rajangam
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Madhusmita Mohanty Mohapatra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
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Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. J Clin Med 2022; 11:jcm11051173. [PMID: 35268264 PMCID: PMC8911306 DOI: 10.3390/jcm11051173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023] Open
Abstract
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition.
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Castillo-Acosta S, Castillo-Acosta JC, Rodríguez-Suárez PM, González-Martín JM, Freixinet-Gilart JL. Outpatient management of persistent air leak. Arch Bronconeumol 2021; 57:722-723. [PMID: 35699021 DOI: 10.1016/j.arbr.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Sara Castillo-Acosta
- Universidad de Las Palmas de Gran Canaria, Spain; Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
| | - José Carlos Castillo-Acosta
- Universidad de Las Palmas de Gran Canaria, Spain; Servicio de Cirugía General y Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pedro Miguel Rodríguez-Suárez
- Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Jesús María González-Martín
- Unidad de Investigación, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Jorge Lorenzo Freixinet-Gilart
- Universidad de Las Palmas de Gran Canaria, Spain; Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Kida H, Muraoka H, Morikawa K, Inoue T, Mineshita M. Pleurodesis After Bronchial Occlusion for Inoperable Secondary Spontaneous Pneumothorax. J Bronchology Interv Pulmonol 2021; 28:290-295. [PMID: 34191760 DOI: 10.1097/lbr.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In many cases of secondary spontaneous pneumothorax (SSP), surgery is not feasible. Furthermore, in cases with a collapsed lung or numerous air leaks, pleurodesis is ineffective, and treatment options are severely limited. For these cases, bronchial occlusion might be the only effective treatment, despite the low success rate. If, however, bronchial occlusion can expand the lung and reduce air leakage, it can positively amplify later effects on pleurodesis, resulting in a powerful treatment. We reviewed the clinical data of patients who underwent bronchial occlusion with endobronchial Watanabe spigot (BO-EWS) and pleurodesis to investigate the usefulness of bronchial occlusion therapy in inoperable SSP patients. MATERIALS AND METHODS This single-center, retrospective study reviewed 36 cases of inoperable SSP patients who underwent pleurodesis after BO-EWS from April 2007 to October 2018. Twenty cases were allocated to the air leak analysis group, and 16 cases were included in the pneumothorax volume analysis group. The Robert David Cerfolio classification and the Collins method were used to evaluate air leak and pneumothorax volume, respectively. RESULTS Pneumothorax volumes decreased significantly after BO-EWS from 29.1%±17.3% to 12.1%±8.8%, while the air leak score decreased from 2.9±1.4 to 1.2±1.0. The success rate for chest tube removals in cases that underwent pleurodesis after BO-EWS was 85.0% (17/20). CONCLUSIONS This study demonstrated the synergistic effectiveness of BO-EWS and the usefulness of pleurodesis treatment in inoperable SSP patients with lung collapse or numerous air leaks. We believe that this treatment will benefit patients with inoperable SSP which, until now, has had few treatment options.
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Affiliation(s)
- Hirotaka Kida
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Hiromi Muraoka
- Department of Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Kei Morikawa
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Takeo Inoue
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
| | - Masamichi Mineshita
- Department of Internal Medicine, Division of Respiratory Diseases, St. Marianna University School of Medicine, Kawasaki
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10
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Karampinis I, Galata C, Arani A, Grilli M, Hetjens S, Shackcloth M, Buderi S, Stamenovic D, Roessner ED. Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta-analysis. Thorac Cancer 2021; 12:2648-2654. [PMID: 34477307 PMCID: PMC8520794 DOI: 10.1111/1759-7714.14138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/21/2023] Open
Abstract
Background Postoperative air leaks are a common complication after lung surgery. They are associated with prolonged hospital stay, increased postoperative pain and treatment costs. The treatment of prolonged air leaks remains controversial. Several treatments have been proposed including different types of sealants, chemical pleurodesis, or early surgical intervention. The aim of this review was to analyze the impact of autologous blood pleurodesis in a systematic way. Methods A systematic review of the literature was conducted until July 2020. Studies with more than five adult patients undergoing lung resections were included. Studies in patients receiving blood pleurodesis for pneumothorax were excluded. The search strategy included proper combinations of the MeSH terms “air leak”, “blood transfusion” and “lung surgery”. Results Ten studies with a total of 198 patients were included in the analysis. The pooled success rate for sealing the air leak within 48 h of the blood pleurodesis was 83.7% (95% CI: 75.7; 90.3). The pooled incidence of the post‐interventional empyema was 1.5%, with a pooled incidence of post‐interventional fever of 8.6%. Conclusions Current evidence supports the idea that autologous blood pleurodesis leads to a faster healing of postoperative air leaks than conservative treatment. The complication rate is very low. Formal recommendations on how to perform the procedure are not possible with the current evidence. A randomized controlled trial in the modern era is necessary to confirm the benefits.
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Affiliation(s)
- Ioannis Karampinis
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany.,Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Christian Galata
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alireza Arani
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maurizio Grilli
- Department of Library and Information Sciences, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Svetlana Hetjens
- Medical Faculty Mannheim, Institute of Medical Statistic and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Shackcloth
- Division of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Silviu Buderi
- Division of Thoracic Surgery, Royal Brompton Hospital, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eric D Roessner
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
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Campisi A, Dell'Amore A, Gabryel P, Ciarrocchi AP, Sielewicz M, Zhang Y, Gu Z, Faccioli E, Stella F, Rea F, Fang W, Piwkowski C. Autologous blood patch pleurodesis: a large retrospective multicenter cohort study. Ann Thorac Surg 2021; 114:273-279. [PMID: 34375648 DOI: 10.1016/j.athoracsur.2021.06.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prolonged air leaks (PAL) complicate 10-15% of lung resections, delaying chest tube removal and prolonging length of hospital stay (LOS). Non consensus exists for managing this common complication, despite favourable results for autologous blood patch pleurodesis (ABPP) in the literature. The aim of this study was to evaluate the effectiveness and safety of ABPP. METHODS We retrospectively reviewed medical records of 510 patients with PAL after lobectomy in four centers, between January 2010 and December 2019. They were divided into two groups: Group A composed of patients who received ABPP for PAL of more than 5 days and Group B in which no ABPP or other procedure was performed for PAL unless strictly necessary. Propensity score-matched (PSM) analysis was performed, and 109 patients were included in each group. Time to cessation of air leak and chest tube removal, LOS, reoperation and complications rate were examined. RESULTS After the PSM, ABPP significantly reduced the number of days before chest tube removal (8.12vs9.30,p=0.004), and LOS (10.0vs11.0,p=0.045) with less perioperative complications (6vs17,p=0.015). Furthermore ABPP was related to lower incidence of any additional invasive procedures (0vs9,p=0.002) and reoperation (0vs4,p=0.044). No patient in the ABPP group had long term complications related to pleurodesis. CONCLUSIONS ABPP is safe and effective in reducing LOS and leads to earlier chest tube removal without increasing complications.
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Affiliation(s)
- Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China; Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy.
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Magdalena Sielewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Eleonora Faccioli
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Federico Rea
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Via Giustiniani 1, Padua (PD), Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Hugen N, Hekma EJ, Claessens NJM, Smit HJM, Reijnen MMPJ. Efficacy of an autologous blood patch for prolonged air leak, a systematic review. Ann Thorac Surg 2021; 114:1064-1071. [PMID: 34115999 DOI: 10.1016/j.athoracsur.2021.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prolonged air leak (PAL) following pulmonary surgery remains a clinical challenge and sometimes needs surgical reintervention. An autologous blood patch (ABP) may provide a noninvasive method to cease air leak. Its value, however, is debatable. The aim of this systematic review is to synthesize evidence regarding the efficacy of ABP in patients with PAL. METHODS A comprehensive search for published studies was performed in the Medline database, Embase and the Cochrane library. Randomized controlled trials, case-control studies and case series in which a postoperative ABP was performed were included. Findings from these studies were tabulated and data was synthesized graphically. PROSPERO registration number CRD42020157591. RESULTS A total of 8 studies was included in the analysis, comprising 151 patients. Studies demonstrated heterogeneity in ABP timing and practice and an intermediate to high risk of bias was scored. The majority of studies demonstrated a beneficial effect of the ABP, with a high rate of success of over 89%. One randomized trial did not find a difference in time to cease of air leak following ABP compared with conservative tube thoracostomy. The overall complication rate was 10%. CONCLUSIONS Quality of included studies is limited due to lack of comparison groups. Synthesized data in this review demonstrates a high rate of successful procedures and acceptable complication rates, which seems to be encouraging to justify a large randomized clinical trial on the use of ABP for patients who suffer from PAL following thoracic surgery.
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Affiliation(s)
- Niek Hugen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Department of Surgery, Radboud university medical center, the Netherlands.
| | - Edo J Hekma
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Niels J M Claessens
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans J M Smit
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel M P J Reijnen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Hasan IS, Allen MS, Cassivi SD, Harmsen WS, Mahajan N, Nichols FC, Reisenauer J, Shen RK, Wigle DA, Blackmon SH. Autologous blood patch pleurodesis for prolonged postoperative air leaks. J Thorac Dis 2021; 13:3347-3358. [PMID: 34277031 PMCID: PMC8264717 DOI: 10.21037/jtd-20-1761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
Background A prolonged air leak (PAL) is the most frequent complication after pulmonary resection. This study aimed to assess the safety and efficacy of autologous blood patch pleurodesis (ABPP) to treat PAL. Methods A prospectively maintained database identified patients with a PAL after pulmonary resection for lung cancer between 2015–2019. In this observational cohort study, clinical data were collected to retrospectively compare patients undergoing ABPP to no ABPP in a propensity-matched analysis. Kaplan Meier estimates and Cox models accounting for inverse probability weighting (IPTW) were used to assess the association of ABPP with each outcome. Results Of the 740 patients undergoing lung resection, 110 (15%) were identified as having a PAL at postoperative day (POD) 5. There was no difference between baseline characteristics among those undergoing ABPP (n=34) versus no ABPP (n=76). Propensity-weighted analysis did not reveal a significant association of ABPP treatment with in-hospital complication (P=0.18), hospital length of stay (LOS) (P=0.13), or post-discharge complication (P=0.13). However, ABPP treatment was associated with a lower risk of hospital readmission [P=0.02, hazard ratio (HR) 0.16] and reoperation for air leak or empyema (P=0.05, HR 0.11). Although not statistically significant, the mean chest tube (CT) removal of 11 days for the ABPP group was less than the no ABPP group (16 days) (P=0.14, HR 1.5–2). Those treated with ABPP were less likely to be discharged with a CT (ABPP 7/34, 21% vs. no ABPP 40/76, 53%). There was no statistical difference in empyema development between groups (ABPP 0/34, 0% vs. no ABPP 4/76, 5%, P=0.39, HR 0.24). Conclusions ABPP administration is safe compared to traditional PAL management. In a retrospective propensity-matched analysis, postoperative patients treated with ABPP required less readmission and reoperation for PAL. Larger powered randomized trials may demonstrate the magnitude of benefit from treatment with ABPP.
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Affiliation(s)
- Irsa S Hasan
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark S Allen
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephen D Cassivi
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nandita Mahajan
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Francis C Nichols
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Janani Reisenauer
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert K Shen
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dennis A Wigle
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shanda H Blackmon
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
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Castillo-Acosta S, Castillo-Acosta JC, Rodríguez-Suárez P, González-Martín JM, Freixinet-Gilart JL. Outpatient Management of Persistent Air Leak. Arch Bronconeumol 2021; 57:S0300-2896(21)00140-X. [PMID: 33994242 DOI: 10.1016/j.arbres.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Sara Castillo-Acosta
- Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España.
| | - José Carlos Castillo-Acosta
- Universidad de Las Palmas de Gran Canaria. Servicio de Cirugía General y Aparato Digestivo. Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Pedro Rodríguez-Suárez
- Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Jesús María González-Martín
- Unidad de Investigación, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
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15
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Zhang L, Xie T, Fu Y, Wu H. Assessment and review of treatment for secondary spontaneous pneumothorax using medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis. Ther Adv Respir Dis 2021; 15:1753466620986390. [PMID: 33573519 PMCID: PMC7887667 DOI: 10.1177/1753466620986390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS To evaluate the efficacy of medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis in spontaneous pneumothorax. PATIENTS AND METHODS Three male patients with spontaneous pneumothorax were treated; medical thoracoscopy-assisted argon plasma coagulation combined with autologous blood pleurodesis was conducted for all patients whose duration of the air leak exceeded 7 days. We systematically reviewed all of the relevant literature to analyze and sum up the treatments of secondary spontaneous pneumothorax. RESULTS The air leaks were all sealed and no recurrence of pneumothorax was reported. No complications of fever, bleeding, or signs of infection were observed during the process. CONCLUSION The authors believe that the combination of medical thoracoscopy-assisted argon plasma coagulation and autologous blood pleurodesis is safe and effective. However, due to the number of patients included in this uncontrolled case study, more cases will be collected in the future.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, China
| | - Tian Xie
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yihui Fu
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Haihong Wu
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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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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Application of autologous blood patch in patients with non-expanded lungs and persistent air leak. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:521-526. [PMID: 32953216 DOI: 10.5606/tgkdc.dergisi.2020.18983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/18/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the effectiveness of pleurodesis procedure by ensuring the expansion of the lung and occluding lung parenchyma leaks with an autologous blood patch. Methods A total of 24 patients (17 males, 7 females; mean age 59.9±12.2 years; range, 30 to 86 years) who underwent autologous blood patch pleurodesis in our clinic between November 2015 and November 2019 were retrospectively analyzed. The patients were not eligible to undergo chemical pleurodesis due to a nonexpandable lung or poor general condition. Demographic and clinical characteristics of the patients and postoperative data were evaluated. Results The air leak stopped within 48 h after autologous blood patch pleurodesis in seven patients. The air leak significantly decreased in 13 patients, while it remained unchanged in four patients. A Heimlich valve was placed in the patients in whom the air leak stopped or significantly decreased. The follow-up chest X-rays showed that the respective lungs of these patients became completely expandable. Conclusion Our study results suggest that the autologous blood patch procedure is a favorable option for the patients who are unable to benefit much from the conventional chemical pleurodesis methods due to contraindications to surgery or the presence of non-expandable lungs.
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Ploenes T, Kyritsis I, Mardanzai K, Muhmann D, Langehegermann L, Slama A, Hegedüs B, Aigner C. A Prospective Study Investigating Blood Patch Pleurodesis for Postoperative Air Leaks After Pulmonary Resection. J Surg Res 2020; 255:240-246. [PMID: 32570126 DOI: 10.1016/j.jss.2020.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prolonged air leaks (PALs) after lung resection are one of the most common complications in thoracic surgery. Several options are available to treat PALs. The autologous blood patch pleurodesis is commonly used but has not been thoroughly investigated. MATERIALS AND METHODS We conducted a prospective randomized study including all consecutive patients with PALs after pulmonary resections. Patients were randomized to either having received pleurodesis by injecting 100 mL autologous blood at d 5 and 6 (Group A) or being placed under observation (Group B). Patients from either group undergoing revisions were further investigated by a post hoc analysis and formed Group C. RESULTS A total of 24 patients were included: 10 patients were randomized to group A and 14 to group B. Six patients (3 from each group) underwent surgical revision and were included in Group C. Groups A and B did not differ in baseline characteristics. The median time to drainage removal was 9 d (range: 5-23 d) in Group A; 9 d (range: 2-20 d) in Group B; and 6 d in Group C (range: 3-10 d), (A/B versus C, P < 0.04; A versus B was not significant). CONCLUSIONS There is no evidence indicating a benefit for blood patch pleurodeses in patients undergoing lung resections and presenting with postoperative PALs for more than 5 d. An early operative closure of postoperative air leakage seems to be more effective.
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Affiliation(s)
- Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ioanis Kyritsis
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - David Muhmann
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Linda Langehegermann
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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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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21
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Lazarus DR, Casal RF. Persistent air leaks: a review with an emphasis on bronchoscopic management. J Thorac Dis 2017; 9:4660-4670. [PMID: 29268535 DOI: 10.21037/jtd.2017.10.122] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax. Its management can be complex and challenging. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Surgical management and medical pleurodesis have long been the usual treatments for PAL. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques.
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Affiliation(s)
- Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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22
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Muruganandan S, Kumar S, Lee YCG. Blood Patch for Pneumothorax: a Literature Review. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0163-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Abd El Hafeez AM, Fathallah WF. Ultrasound-guided pleurodesis with doxycycline in patients with hepatic hydrothorax. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.176661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The efficacy and economical benefits of blood patch pleurodesis in secondary spontaneous pneumothorax patients. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:21-5. [PMID: 27212974 PMCID: PMC4860430 DOI: 10.5114/kitp.2016.58960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 10/15/2013] [Accepted: 02/04/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Prolonged 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 METHODS First-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. RESULTS Thirty-one (27 male, 4 female) SSP patients with expanded lungs on chest X-ray and resistant air leak on the 3(rd) 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. CONCLUSIONS Autologous 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.
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Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T. Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak? Eur J Cardiothorac Surg 2016; 50:118-23. [DOI: 10.1093/ejcts/ezv455] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/04/2015] [Indexed: 11/15/2022] Open
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Qi F, Tian Q, Chen L, Li C, Zhang S, Liu X, Xiao B. Use of endobronchial valve insertion to treat relapsing pneumothorax: a case report and literature review. CLINICAL RESPIRATORY JOURNAL 2015; 11:411-418. [PMID: 26259915 DOI: 10.1111/crj.12355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 06/24/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Backgorund and Aims: Unidirectional endobronchial valves have recently been shown to be beneficial as treatment for persistent air leaks. This report presents a first case of endobronchial valve implantation to treat relapsing pneumothorax in a Chinese patient, and also presents a review of the literature on the use of one-way valve insertion for the treatment of persistent air leaks. METHODS The patient did undergo a recent but failed chest tube intervention. By bronchoscopy and using Chartis® system measurements, the upper left lobe (including the left apical bronchus) was closed using a catheter. RESULTS After the expected decrease in airflow following bronchial occlusion, increased air pressure and decreased spilled air were noted; it was concluded that the pneumothorax was located in the left upper lobe. A Zephyr® endobronchial valve was placed in the left upper apical bronchus. The health benefits of the procedure were noticed in the following days. CONCLUSION Our review suggests that the use of endobronchial valves could be used as an effective, minimally invasive, low-risk intervention for patients with pneumothorax that cannot be treated surgically.
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Affiliation(s)
- Fei Qi
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Qing Tian
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Liang'an Chen
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Chunyan Li
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Shu Zhang
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xingchen Liu
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Binbin Xiao
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
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27
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How CH, Chen JS. Chemical pleurodesis for first presentation of primary spontaneous pneumothorax. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Oppenheimer N, Klainbart S, Merbl Y, Bruchim Y, Milgram J, Kelmer E. Retrospective evaluation of the use of autologous blood-patch treatment for persistent pneumothorax in 8 dogs (2009-2012). J Vet Emerg Crit Care (San Antonio) 2014; 24:215-20. [PMID: 24739036 DOI: 10.1111/vec.12152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the clinical course, outcome and success rate of 8 dogs with persistent pneumothorax treated with autologous blood-patch pleurodesis (ABP). DESIGN Retrospective case series. SETTING University teaching hospital ANIMALS Eight client-owned dogs. INTERVENTION Non-coagulated blood was aseptically collected from the jugular vein and injected immediately into the pleural cavity of dogs with persistent pneumothorax. MEASUREMENTS AND MAIN RESULTS The procedure was successful in 7 of 8 dogs. The median duration of pneumothorax until the ABP was performed was 4 days (range 2-6 days). Pneumothorax resolved immediately after 1 treatment in 4 dogs. Pleurodesis was repeated once in 3 dogs, and twice in 1 case after which it resolved in 3 of the 4 dogs. Out of a total of 13 ABP procedures performed in 8 dogs, 5 (62.5%) were successful after 1 procedure and the success rate increased to 87.5% after additional procedures. One dog failed ABP and was euthanized 3 days later due to continued deterioration and a hospital acquired pneumonia. Mild to moderate complications occurred in 2 other dogs and resolved in both. CONCLUSIONS ABP is a simple, inexpensive, and relatively safe procedure which can be considered in dogs with persistent pneumothorax that have failed conservative or surgical management. Infections following ABP were documented in 2 of the 8 dogs and resolved in 1 dog.
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Affiliation(s)
- Nama Oppenheimer
- Department of Small Animal Emergency and Critical Care, Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel, 76100
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Kagohashi K, Ohara G, Shiozawa T, Tamura T, Miyazaki K, Kurishima K, Satoh H, Hizawa N. Blood-patch pleurodesis for pneumothorax in lung fibrosis due to progressive systemic sclerosis: A case report. Exp Ther Med 2014; 8:1919-1921. [PMID: 25371756 PMCID: PMC4218704 DOI: 10.3892/etm.2014.1993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/10/2014] [Indexed: 11/14/2022] Open
Abstract
Pneumothorax in patients with progressive systemic sclerosis (PSS) often presents as a difficult-to-treat disease. Autologous blood-patch pleurodesis has previously been used for the treatment of pneumothorax. Blood outside its own environment is an irritant; therefore, chest physicians must watch closely for an allergic reaction. The injection is simple, painless, causes no side effects, is an inexpensive treatment for pneumothorax and is available not only in patients with persistent air leak but also in those with residual air space. A case is reported here of blood-patch pleurodesis for pneumothorax in lung fibrosis due to PSS. As an alternative therapy for difficult-to-treat pneumothorax in patients with PSS with persistent air leak and residual air space, autologous blood-patch pleurodesis would be one of the treatment options.
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Affiliation(s)
- Katsunori Kagohashi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Gen Ohara
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Toshihiro Shiozawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Tomohiro Tamura
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Kunihiko Miyazaki
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Koichi Kurishima
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
| | - Nobuyuki Hizawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Mito, Ibaraki 310-0015, Japan
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How CH, Hsu HH, Chen JS. Chemical pleurodesis for spontaneous pneumothorax. J Formos Med Assoc 2013; 112:749-55. [PMID: 24268613 DOI: 10.1016/j.jfma.2013.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 11/29/2022] Open
Abstract
Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.
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Affiliation(s)
- Cheng-Hung How
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Autologous blood pleurodesis for persistent pulmonary air leak during pregnancy. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Autologous blood patch for persistent air leak in children. J Pediatr Surg 2013; 48:1862-6. [PMID: 24074658 DOI: 10.1016/j.jpedsurg.2012.12.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/13/2012] [Accepted: 12/08/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE Persistent air leak (PAL) is associated with increased morbidity. Standard treatment of PAL includes chemical or mechanical pleurodesis. Long-term impact of these interventions is not known in the pediatric population. Autologous blood patch (ABP) offers a novel treatment option. We report our experience with autologous blood patch to successfully treat PAL in eight children. METHODS Children with PAL were treated with ABP. A fresh whole blood sample was obtained from each patient and injected via their pre-existing chest tube. Volume of blood injected, time to cessation of air leak, time to chest tube removal, outcomes and complications were reviewed. RESULTS Eight children aged 2 months to 18 years underwent ABP. Three children had immediate seal of air leak, while two patients sealed after 1 and 2 days. Three patients required a second ABP, after which they had immediate seal of air leak. Chest tubes were removed within 2-3 days in 7 cases. One child developed an asymptomatic pneumothorax and required 8 days for radiographic resolution. CONCLUSION ABP appears to be a safe and effective treatment option for PAL in children. ABP offers an inexpensive, easy to perform technique and avoids use of toxic chemicals for pleurodesis in pediatric patients.
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Abstract
PURPOSE OF REVIEW Persistent air leak (PAL) poses a significant challenge to the thoracic surgeon. Of the numerous methods employed to manage this problem, autologous blood 'patch' pleurodesis (ABPP) remains one of the most controversial, seemingly due to a lack of robust data and consensus of opinion regarding its efficacy, technique of application and its role in clinical practice. Despite a lack of randomized control trials, the evidence to-date has shown ABPP to be an efficacious, cheap, simple, well tolerated and readily available treatment, with minimal side effects and broad range of applications, allowing for earlier chest drain removal, decreased complications and decreased hospital stay. A review is therefore required to assess the role for ABPP in contemporary clinical practice. RECENT FINDINGS Recent studies have demonstrated that ABPP is an effective management for PAL in specific patient groups and there is an argument that it has the potential to be the gold-standard or first-line treatment in certain clinical scenarios such as for patients with interstitial lung disease or acute respiratory distress syndrome. SUMMARY This review aims to discuss the relevance of recent findings and to suggest a firm role for ABPP in current practice. In addition, the evidence for the efficacy of ABPP will be assessed and compared with other established methods of pleurodesis. Finally, the review will include a summary of relevant research to-date in order to suggest an evidence-based standardized protocol for the application of ABPP.
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34
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Cao GQ, Kang J, Wang F, Wang H. Intrapleural Instillation of Autologous Blood for Persistent Air Leak in Spontaneous Pneumothorax in Patients With Advanced Chronic Obstructive Pulmonary Disease. Ann Thorac Surg 2012; 93:1652-7. [DOI: 10.1016/j.athoracsur.2012.01.093] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 11/29/2022]
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Iyama S, Sato T, Murase K, Kikuchi S, Kamihara Y, Ono K, Takada K, Miyanishi K, Sato Y, Takimoto R, Kobune M, Obama T, Miyajima M, Watanabe A, Higami T, Hirayama Y, Kato J. Successful treatment by fibrin glue sealant for pneumothorax with chronic GVHD resistant to autologous blood patch pleurodesis. Intern Med 2012; 51:2011-4. [PMID: 22864128 DOI: 10.2169/internalmedicine.51.7355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pneumothorax associated with chronic graft-versus-host disease (cGVHD) after stem cell transplantation is a rare complication. Autologous blood has been used successfully for pleurodesis, which was less toxic than chemical agents. However, when pneumothorax is resistant to pleurodesis, no other procedure is more effective and conservative. Here, we describe a case of myelodysplastic syndromes complicated with cGVHD-related pneumothorax. His pneumothorax has been resistant to pleurodesis using autologous blood and was treated successfully with fibrin glue sealant. In our limited experience, we believe the best success could be achieved when this method is used to treat persistent pneumothorax with cGVHD.
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Affiliation(s)
- Satoshi Iyama
- The Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan
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Cobanoglu U, Melek M, Edirne Y. Autologous blood pleurodesis: A good choice in patients with persistent air leak. Ann Thorac Med 2011; 4:182-6. [PMID: 19881163 PMCID: PMC2801042 DOI: 10.4103/1817-1737.56011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The study compares the efficiency, side effects and complications of autologous blood pleurodesis with talcum powder and tetracycline. MATERIALS AND METHODS This prospective study evaluated 50 patients with persistent air leak resulting from primary and secssondary spontaneous pneumothorax between February 2004 and March 2009. The patients inclussded 32 (64.0%) males and 18 (36.0%) females with a median age of 39 years (range 14-69 years). All cases had persistent air leak of more than seven days. Pleurodesis was performed using autologous blood in 20 (40.0%) patients, talc powder in 19 (38.0%) patients and tetracycline in 11 (22.0%) patients through a chest tube. Air leak cessation times after pleurodesis, side effects and pulmonary function tests (PFT) in the first and third months were measured. RESULTS Recurrent primary spontaneous pneumothorax was the cause of persistent air leak in all cases. Air leaks were expiratory only in 54.0% of cases. We obtained a success rate of 75.0% using autologous blood, 84.2% using talc powder and 63.6% using tetracycline. Mean air leak termination interval was significantly (P < 0.001) shorter in patients treated with autologous blood in comparison to talc powder and tetracycline. We observed a significant (P < 0.05) decline in PFT in patients treated with talc powder compared with tetracycline and autologous blood. Vital capacity, FVC and FEV₁were significantly lower in patients treated with tetracycline compared with autologous blood. CONCLUSION This study shows that autologous blood pleurodesis compared to talc powder and tetracycline is related with shorter leak cessation time and less pulmonary function decline in patients with persistent air leak. We think further randomized clinical trials of pleurodesis as treatment could increase its use in thorax surgery by demonstrating the safety and the efficacy of this procedure.
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Affiliation(s)
- Ufuk Cobanoglu
- Department of Chest Surgery, University of Yuzuncu Yil, Turkey.
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37
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Aihara K, Handa T, Nagai S, Tanizawa K, Watanabe K, Harada Y, Chihara Y, Hitomi T, Oga T, Tsuboi T, Chin K, Mishima M. Efficacy of blood-patch pleurodesis for secondary spontaneous pneumothorax in interstitial lung disease. Intern Med 2011; 50:1157-62. [PMID: 21628929 DOI: 10.2169/internalmedicine.50.4645] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We identified the prognostic relevance of pneumothorax in interstitial lung disease (ILD) patients and evaluated the efficacy and safety of autologous blood-patch pleurodesis. METHODS We retrospectively reviewed 59 occurrences of pneumothorax in 34 ILD patients identified over a 12-year period. RESULTS Air leakage ceased in 16 of 22 (72.7%) episodes after blood pleurodesis and in 11 of 14 (78.6%) episodes after chemical pleurodesis. Both the cure ratio and recurrence ratio in the cure episodes were comparable with those in the chemical pleurodesis group (p=0.99 and 0.99, respectively). In addition, there were no harmful events associated with blood pleurodesis. The median survival time after the first episode of pneumothorax was less than 9 months in patients with idiopathic interstitial pneumonia (IIP) and only around 3 years in the patients with other types of ILD, which have essentially favorable outcomes. Kaplan-Meier survival estimates were significantly worse in the patients with concomitant pneumomediastinum than in those without (p<0.05). A multivariate Cox regression analysis identified that the number of episodes of pneumothorax, IIP diagnosis and concomitant pneumomediastinum were independent predictors of death. CONCLUSION Autologous blood-patch pleurodesis is safe and worth considering as a first-line treatment for pneumothorax secondary to ILD. However, despite treatments, the prognosis after the onset of pneumothorax in ILD patients was found to be poor. In addition, concomitant pneumomediastinum may further worsen the prognosis.
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Affiliation(s)
- Kensaku Aihara
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan
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38
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Merritt RE, Singhal S, Shrager JB. Evidence-based suggestions for management of air leaks. Thorac Surg Clin 2010; 20:435-48. [PMID: 20619236 DOI: 10.1016/j.thorsurg.2010.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The management of postoperative alveolar air leaks (AALs) continues to challenge thoracic surgeons. AALs increase length of stay and health care costs, and likely lead to other postoperative complications. Staple line buttresses, topical sealants, pleural tents, pneumoperitoneum, and modifications of traditional chest tube management (ie, reduced suction) have all been proposed to help reduce AAL. However, the cost of some of the commercial products being marketed may outweigh their relative effectiveness, and some of these techniques and products have not been adequately studied to date. This article provides a review of the available evidence-based literature that addresses the efficacy of the options currently available to prevent and manage AALs. Management suggestions based on this literature are presented.
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Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford Medical Center, 2nd floor Falk Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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39
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Chambers A, Routledge T, Billè A, Scarci M. Is blood pleurodesis effective for determining the cessation of persistent air leak? Interact Cardiovasc Thorac Surg 2010; 11:468-72. [PMID: 20628018 DOI: 10.1510/icvts.2010.234559] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anthony Chambers
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, UK
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40
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Merbl Y, Kelmer E, Shipov A, Golani Y, Segev G, Yudelevitch S, Klainbart S. Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia. J Am Vet Med Assoc 2010; 237:299-303. [PMID: 20673111 DOI: 10.2460/javma.237.3.299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. CLINICAL FINDINGS Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, gamma-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. TREATMENT AND OUTCOME Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. CONCLUSIONS AND CLINICAL RELEVANCE Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration>5 days) pneumothorax when surgery is not an option.
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Affiliation(s)
- Yael Merbl
- Department of Small Animal Emergency and Critical Care, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot 76100, Israel
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41
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Karangelis D, Tagarakis GI, Daskalopoulos M, Skoumis G, Desimonas N, Saleptsis V, Koufakis T, Drakos A, Papadopoulos D, Tsilimingas NB. Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe? J Cardiothorac Surg 2010; 5:61. [PMID: 20716367 PMCID: PMC2933601 DOI: 10.1186/1749-8090-5-61] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax. PATIENTS AND METHODS A number of 15 patients (10 male and 5 female) were included in this prospective study between March 2005 and December 2009. The duration of the air leak exceeded 7 days in all patients. The application of blood pleurodesis was used as the last preoperative conservative method of treatment in 12 patients. One patient refused surgery and two were ineligible for operation due to their comorbidities. A blood sample of 50 ml was obtained from the patient's femoral vein and immediately introduced into the chest tube. RESULTS A success rate of 27% was observed having the air leak sealed in 4 patients in less than 24 hours. CONCLUSION Despite our disappointingly poor outcome, the authors believe that the procedure's safety, convenience and low cost establish it as a worth trying method of conservative treatment for patients with the aforementioned pathology for whom no other alternative than surgery would be a choice.
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Affiliation(s)
- Dimos Karangelis
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Thessaly, Larissa, Greece.
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42
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Singhal S, Ferraris VA, Bridges CR, Clough ER, Mitchell JD, Fernando HC, Shrager JB. Management of alveolar air leaks after pulmonary resection. Ann Thorac Surg 2010; 89:1327-35. [PMID: 20338378 DOI: 10.1016/j.athoracsur.2009.09.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/04/2009] [Accepted: 09/10/2009] [Indexed: 11/18/2022]
Abstract
Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality. Air leaks are associated with prolonged hospital stays, and infectious and cardiopulmonary complications, and they occasionally require reoperation. Despite reasonably robust literature on the topic, the optimal approaches to manage postoperative air leaks remain controversial. We used available literature and expert consensus to formulate suggestions regarding the preferred approaches to both routine and prolonged alveolar air leaks. This review summarizes our findings.
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Affiliation(s)
- Sunil Singhal
- Division of Thoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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43
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Autologous blood pleurodesis for treatment of prolonged air leak in secondary spontaneous pneumothorax. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-009-0054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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44
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45
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Montcriol A, Prunet B, Bordes J, Raymond A, Meaudre E. [Autologous "blood patch" pleurodesis: a helpful procedure]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2009; 28:102-103. [PMID: 19038530 DOI: 10.1016/j.annfar.2008.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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46
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The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med 2008; 14:343-7. [DOI: 10.1097/mcp.0b013e3282fcea76] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Akcakus M, Koklu E, Bilgin M, Kurtoglu S, Altunay L, Canpolat M, Budak N. Congenital pulmonary lymphangiectasia in a newborn: a response to autologous blood therapy. Neonatology 2007; 91:256-9. [PMID: 17568156 DOI: 10.1159/000098172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/05/2006] [Indexed: 12/16/2022]
Abstract
Congenital pulmonary lymphangiectasia is a rare condition that may present antenatally with pleural effusions and hydrops, and the prognosis is reported to be very poor. Treatments for lymphangiectasia have included corticosteroids for patients with primary inflammatory conditions, dietary modifications, surgical resection for isolated lesions, octreotide, antiplasmin therapy and fibrin glue pleurodesis. However, there is no experience with pleurodesis by autologous blood therapy in the literature. We present a newborn with primary pulmonary lymphangiectasis who developed progressively profuse chylous pleural effusions after enteral full feeding from the 8th day of life and improved with pleurodesis by autologous blood therapy.
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Affiliation(s)
- Mustafa Akcakus
- Division of Neonatology, Department of Paediatrics, School of Medicine, Erciyes University, Kayseri, Turkey
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48
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Olak J. Invited commentary. Ann Thorac Surg 2006; 82:1056. [PMID: 16928535 DOI: 10.1016/j.athoracsur.2006.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 05/09/2006] [Accepted: 05/11/2006] [Indexed: 11/18/2022]
Affiliation(s)
- Jemi Olak
- Department of Surgery, Lutheran General Hospital, 1875 Dempster St, Suite 145, Park Ridge, IL60068
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49
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Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M, Canneto B, Sturani C, Muriana G. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg 2006; 132:556-9. [PMID: 16935110 DOI: 10.1016/j.jtcvs.2006.05.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 05/22/2006] [Accepted: 05/23/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Persistent air leak is among the most common complications after pulmonary resection, leading to prolonged hospitalization and increased costs. At present there is not yet a consensus on their treatment. METHODS During a 7-year experience, 21 patients submitted to pulmonary resection were postoperatively treated with an autologous blood patch for persistent air leaks. Persistent air leaks were catalogued twice daily according to the classification previously reported by Cerfolio and associates. Chest radiographs showed a fixed pleural space deficit in 18 (86%) patients. A total of 50 to 150 mL of autologous blood was drawn from the patient and injected into the chest tube, which was removed 48 hours after cessation of the air leak. RESULTS We observed a 4% incidence of persistent air leaks after pulmonary resection in our series. Persistent air leaks were categorized as follows: 14% forced expiratory, 57% expiratory, 29% continuous, and 0% inspiratory. The mean duration of prolonged air leaks was 11 days after surgery. In 81% of the cases examined, a blood patch was only carried out once and gave successful results within 24 hours. In the remaining 19% of cases, the air leak ceased within 12 hours after the second procedure. Mean hospital stay was 15 days. In our experience this procedure had a 100% success rate. CONCLUSIONS Pleurodesis with an autologous blood patch is well tolerated, safe, and inexpensive. This procedure is an effective technique for treatment of postoperative persistent air leaks, even in the presence of an associated fixed pleural space deficit.
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50
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Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural Instillation of Autologous Blood in the Treatment of Prolonged Air Leak After Lobectomy: A Prospective Randomized Controlled Trial. Ann Thorac Surg 2006; 82:1052-6. [PMID: 16928534 DOI: 10.1016/j.athoracsur.2006.04.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 04/03/2006] [Accepted: 04/04/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to assess the value of instilling autologous blood into the pleural cavity to seal prolonged air leaks after lobectomy. METHODS Of 319 lobectomies performed over an 18-month period, 22 patients (6.9%) experienced prolonged air leak (more than 5 days after surgery). Twenty patients consented to be randomly assigned to one of two treatment pathways. The study group received instillation of 120 mL autologous blood into their apical chest drain on the fifth postoperative day, and again if the air leak persisted on days 7 and 9 respectively. No anticoagulation was used for this blood. The control group continued to be treated by tube thoracostomy alone, but if the air leak was still present on the 10th postoperative day they "crossed over" and underwent intrapleural installation of blood as in the study group. RESULTS After instillation of blood, the air leak was sealed by the next day in 58.6% of treatments. The median length of air leak was 5 days in the study group and 11 days in the control group (p < 0.001). Time to chest drain removal (median 6.5 days versus 12 days) and hospital discharge (median 8 days versus 13.5 days) were both significantly (p < 0.001) shorter in the study group. CONCLUSIONS This technique is effective in sealing air leaks after lobectomy. It allows earlier chest drain removal and shortens hospital stay.
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Affiliation(s)
- Michael J Shackcloth
- Department of Thoracic Surgery, The Cardiothoracic Centre, Liverpool, United Kingdom
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