Autologous Blood Patch Pleurodesis: A Reliable Treatment Option For Prolonged Air Leakage in Children (original) (raw)
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Autologous blood patch pleurodesis for prolonged postoperative air leaks
Journal of Thoracic Disease, 2021
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.
Autologous blood pleurodesis: A good choice in patients with persistent air leak
Annals of Thoracic Medicine, 2009
tetracycline derivates and reported about 50% success rates but severe pain after the procedure was observed in some patients. Pleurodesis with talc powder has been used; however, complications such as tachycardia and adult respiratory distress syndrome (ARDS) have also been reported. [6,7] Pleurodesis with autologous blood has been recommended as an effective, painless, inexpensive and simple method in the treatment of persistent air leaks. [8,9] This prospective study was conducted to compare the results of pleurodesis performed with autologous blood, talc powder and tetracycline in persistent air leaks. Materials and Methods Between February 2004 and March 2009, 50 patients with persistent air leaks resulting from primary and secondary spontaneous pneumothorax were evaluated. Patients were P ersistent air leak is a frequent problem that can occur as a result of traumatic and spontaneous pneumothorax and after pulmonary surgery. [1] This condition causes long durations of hospital stay and carries the risk of respiratory infections, empyema and deep venous thrombosis. [2] Treatment usually includes tube thoracostomy with aspiration and chemical pleurodesis to seal the leak. [3] Other interventions such as re thoracotomy and surgical repair or biological glues are also used. [4] Pleurodesis is caused by adhesion of parietal and visceral pleura to eliminate the pleural space. This can be achieved surgically by thoracotomy or thoracostomy causing mechanical abrasion or by using chemical sclerosing materials via thoracoscopy or chest tube. Several agents such as bleomycine, cyanoacrilate, tetracycline derivates and talc powder are used to perform pleurodesis. [5] Although several studies on pleurodesis exist, there is no consensus on which agent and what dose should be used.
Is blood pleurodesis effective for determining the cessation of persistent air leak?
Interactive cardiovascular and thoracic surgery, 2010
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed whether blood pleurodesis is effective for cessation of persistent air leak (PAL). Altogether more than 43 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that autologous blood pleurodesis has superior outcomes when compared with conservative management for treatment of postoperative PAL. In addition, for PAL causing pneumothorax, blood pleurodesis [optimal volume 100 ml (from two studies)] should be considered in patients who are unsuitable for surgery, talc pleurodesis is ineffective or not viable (including cases complicated by acute respiratory distress syndrome) and a prompt resolution is required. Some 70-81% of patients treated for po...
Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax
Journal of the Formosan Medical Association, 2014
Background/Purpose: Prolonged air leak is the most common complication after thoracoscopic operation for primary spontaneous pneumothorax (PSP), and the role of chemical pleurodesis in treating air leaks remains unclear. This study evaluated the safety and efficacy of chemical pleurodesis with a comparison between minocycline and OK-432. Methods: Between 1994 and 2011, 1083 PSP patients were treated by thoracoscopic operation. After the operation, patients with persistent air leak for 3 days or more were managed by minocycline or OK-432 pleurodesis. The demographic and outcome data for these patients were collected by retrospective chart review. Results: Seventy-nine patients (7.3%) with prolonged air leak after thoracoscopy underwent minocycline pleurodesis (60 patients) or OK-432 pleurodesis (19 patients) as the primary treatment. The primary success rate was 63% (38/60) for minocycline pleurodesis and 95% (18/19) for OK-432 pleurodesis (p Z 0.009). Postpleurodesis pain was common and comparable between the two groups. No major complications were noted after a total of 121 treatments. Patients undergoing primary OK-432 pleurodesis had shorter durations of postpleurodesis chest drainage (mean 8.5 vs. 2.3 days; p < 0.001) and postoperative hospital stay (mean 11.9 vs. 6.8 days; p < 0.001) than those undergoing primary minocycline pleurodesis. After a median follow-up of 16 months, recurrence was noted in one patient in the OK-432 group and none in the minocycline group. Long-term pulmonary function in the two groups was comparable.
Objective: Pneumothorax is present as a frequent complication in acute respiratory distress syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary surgery. The goal of this study was to compare PAB with the conventional drain and water seal in the management of PAL in patients with ARDS and pneumothorax. Design: The study was a case-control, prospective, nonrandomized one comparing 2 groups subjected to artificial pairing (1:1). Setting: The study took place at the Torrecardenas Hospital (Andalusian Health Service, AlmerÃa, Spain). Patients: Participants were 2 groups of 27 patients, all with ARDS, pneumothorax, and PAL. Interventions: One group received conventional treatment whereas the other received PAB. Main results: The severity of the conditions of both groups is homogeneous, shown by sex; age; Murray, Marshall, and Acute Physiology and Chronic Health Evaluation II scores; and etiology of ARDS. The patients in the PAB group had a shorter stay in the ICU, shorter weaning time (WT), and lower death rate. The average differences between the groups were 11 days less WT (adjusted odds ratio [OR] = 0.1) and 9 days less on average 0883-9441/$ -see front matter D Journal of Critical Care (2006) 21, 209 -216 time spent in the ICU (adjusted OR = 0.24). The death rates in the PAB group and the control group were 3.7% and 29.6%, respectively (adjusted OR = 0.6). Conclusions: The use of PAB makes possible a decrease in ventilator WT and a shorter stay in the ICU, with a resulting increase in functional recuperation and decrease in patient mortality. D
Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?
The American Journal of Surgery, 2014
BACKGROUND: Surgery as the primary management strategy for pediatric primary spontaneous pneumothorax is controversial. This study aims to evaluate the outcomes and effectiveness of management approaches for pediatric spontaneous pneumothorax. METHODS: Outcomes of pediatric patients undergoing initial nonoperative treatment versus videoassisted thoracoscopic surgery with blebectomy and mechanical pleurodesis were compared via a retrospective review. RESULTS: We identified 96 patients with 108 pneumothoraces. Of 98 pneumothoraces with initial nonoperative management, 37% had surgery during their initial hospitalization for persistent air leak. Of those discharged home without video-assisted thoracoscopic surgery, 40% recurred. Initial nonoperative management resulted in more total hospital days (median: 11 vs 5 days, P , .001). No significant predictors of recurrence were identified on multivariate analysis. Sixty-three percent of all patients ultimately required surgery. CONCLUSIONS: Fewer than 40% of primary spontaneous pneumothorax patients are definitively treated with nonoperative management. A prospective study is needed to determine whether primary surgery with blebectomy/mechanical pleurodesis is a more effective treatment strategy.
Thoracoscopic treatment of spontaneous pneumothorax in children
Journal of Pediatric Surgery, 2003
This study describes the authors experience and results with thoracoscopic treatment of spontaneous pneumotrorax (SP) in 22 children. Methods: A total of 32 thoracoscopic procedures were performed in 22 children. The patients ranged in age from 9 to 21 years at the time of their first thoracoscopy. SP was primary in 9 and secondary in 13 patients. Pleurodesis was performed in all thoracoscopies using talc in 28 and pleural abrasion in 4 procedures. In 2 of these, apical pleurectomy was added to abrasion. Blebectomy was the additional surgical procedure associated with pleurodesis in 4 patients. Results: Thoracoscopy usually was performed with the patient under general anesthesia. In children with severe respiratory insufficiency, regional anesthesia was used. The mean operative time was 42.6 minutes (range, 8 to 114 minutes). The mean time of postoperative chest tube drainage was 4.6 days (range, 2 to 12 days). Three patients with cystic fibrosis had prolonged air leak lasting longer than 7 days after tho-racoscopy. None of them required an additional surgical intervention, and the air leak ceased in 8, 8, and 12 days with continuous suction. One patient required a repeat thoracoscopy for bleeding from an intercostal artery on postoperative day one. The mean follow-up was 4 years (range, 2.5 months to 14 years). There have been 2 partial recurrences (6.25%), both in patients with secondary SP, which were treated by a repeat thoracoscopy and talc pleurodesis. Conclusions: Thoracoscopic treatment of SP is safe and effective in children. It can be performed under regional anesthesia also in children with severe respiratory insufficiency. Because the complications and recurrences are encountered more frequently in children with an underlying lung disease, special care in surgical manipulation is required in this subgroup of patients with SP.
Autologous blood patching in the management of broncho-pleural fistula in spontaneous pneumothorax
Journal of Society of Surgeons of Nepal, 2017
Introduction: Autologous blood patching (ABP) has been described as a modality of treatment of bronchopleural fistulas (BPF). The success rates have varied chiefly because the numbers studied have been small and the populations inhomogeneous. We conducted this study to determine the success rate in patients with BPF of spontaneous onset.Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included These patients underwent one to three episodes of blood patching in 50ml aliquots. Demographic profile, smoking status, success rate and complications were recorded and compared.Results: Between July 2011 and January 2014, seventy-six patients underwent ABP. The overall success rate of ABP was 58%. Twenty one were successful in first attempt (27.6%), a further 12/55 (22%) in the second and 11/43 (25%) in third attempt. The success rates did not differ significantl...