Autologous Blood Patching in the Management of Broncho-pleural Fistula in Spontaneous Pneumothorax
Abstract
Introduction: Autologous blood patching (ABP) has been described as a modality of treatmentof 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 includedThese 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 significantly with etiology of spontaneous pneumothorax (P = 0.706); smoking status (P value = 0.958); duration of air leak prior to ABP (P= 0.149) and presence of residual pneumothorax after chest tube insertion (P= 0.176). Seven complications (3=pleural infections, 1= surgical emphysema, 1= expansion of pneumothorax and 2= recurrence) occurred. Infectious complications occurred in patients who received two or more instillations of blood.Conclusion: ABP achieved a modest success rates in our experience. Two or more attempts may be necessary to attain a successful result but one has to be mindful of the possibility of infection.References
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13. Karangelis D, Tagarakis GI, Daskalopoulos M, Skoumis G, Desimonas N, Saleptsis V et al. Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe? J Cardiothorac Surg. 2010 Aug 17; 5: 61-5.
14. Özpolat B, Gazyagci S, Gozubuyuk A, Ayva S Atinkaya C. Autologous blood pleurodesis in rats to elucidate the amounts of blood required for reliable and reproducible results. J surg Res. 2010 Jun 15; 161(2): 228-32.
15. Cao G, 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.
16. Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural instillation of autologous blood in the treatment of prolonged air leakafter lobectomy: a prospective randomized controlled trial. Ann Thorac Surg. 2006;82: 1052-6.
17. Jones NC, Curry P, Kirk AJ. An alternative to drain clamping for blood pleurodesis. Eur J Cardiothorac Surg. 2005;27:935-9.
18. Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M. Autologous blood patch in persistent air leaks after pulmonary resection.J ThoracCardiovasc Surg. 2006;132:556–9.
19. Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. ScandCardiovasc J. 1998;32: 75–8.
2. Almassi GH, Haasler GB. Chemical pleurodesis in the presence of persistent air leak. Ann Thorac Surg. 2001;72:1716-9.
3. Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest. 1997;112:822-8.
4. Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E. Spontaneous Pneumothorax in Chronic Obstructive pulmonary disease: complications, treatment and recurrences. Eur J Respir Dis, 1987;71:365-71.
5. Robinson CL. Autologous blood pleurodesis in recurrent and spontaneous pneumothorax. Can J Surg. 1987;30:428-9.
6. Dumire R, Crabbe MM, Mappin FG, Fontelle LJ. Autologous ‘ blood patch’ pleurodesis for persistent pulmonary air leak . Chest. 1992;101:64-6.
7. Rivas de Andres JJ, Blanco S, De la Torre M. Post Surgical pleurodesis with autologous blood in patients with persistent air leak. Ann Thorac Surg. 2000;70:270-2.
8. Lang-Lazdunski L, Coonar AS. A prospective study of autologous ‘blood patch’ pleurodesis for persistent air leak after pulmonary resection. Eur J CardiothoracSurg 2004;26:897-900.
9. Özpolat B. Autologous blood patch pleurodesis in the management of prolonged air leak. ThoracCardiov Surg. 2010;58:52-8.
10. Oliveira FH, Cataneo DC, Ruiz RL Jr, Cataneo AJ. Persistent pleuropulmonary air leak treated with autologous blood: results from a university hospital and review of literature. Resp. 2010;79(4):302-6.
11. Athanassiadi K, Bagaev E, Haverich A. Autologous blood pleurodesis for persistent air leak. ThoracCardiovasc Surg. 2009 Dec;57(8):476-9.
12. Chambers A, RoutledgeT.Bille A, Scarci M. Is blood pleurodesis effective for determining the cessation of persistent air leak? Inter CardiovascThorac Surg. 2010;11: 468-72.
13. Karangelis D, Tagarakis GI, Daskalopoulos M, Skoumis G, Desimonas N, Saleptsis V et al. Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe? J Cardiothorac Surg. 2010 Aug 17; 5: 61-5.
14. Özpolat B, Gazyagci S, Gozubuyuk A, Ayva S Atinkaya C. Autologous blood pleurodesis in rats to elucidate the amounts of blood required for reliable and reproducible results. J surg Res. 2010 Jun 15; 161(2): 228-32.
15. Cao G, 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.
16. Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural instillation of autologous blood in the treatment of prolonged air leakafter lobectomy: a prospective randomized controlled trial. Ann Thorac Surg. 2006;82: 1052-6.
17. Jones NC, Curry P, Kirk AJ. An alternative to drain clamping for blood pleurodesis. Eur J Cardiothorac Surg. 2005;27:935-9.
18. Droghetti A, Schiavini A, Muriana P, Comel A, De Donno G, Beccaria M. Autologous blood patch in persistent air leaks after pulmonary resection.J ThoracCardiovasc Surg. 2006;132:556–9.
19. Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. ScandCardiovasc J. 1998;32: 75–8.
Published
2017-08-10
How to Cite
THAPA, Bivhusal; SAPKOTA, Ranjan; SAYAMI, Prakash.
Autologous Blood Patching in the Management of Broncho-pleural Fistula in Spontaneous Pneumothorax.
J Soc Surg Nep, [S.l.], v. 18, n. 2, p. 23-28, aug. 2017.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=236>. Date accessed: 01 dec. 2023.
Issue
Section
Original Article
Keywords
Broncho-pleural fistula; persistent air leak; pneumothorax
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