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A prospective study of autologous 'blood patch' pleurodesis for persistent air leak after pulmonary resection
Loïc Lang-Lazdunski1, Aman S Coonar
1Department of Thoracic Surgery, Guy's Hospital, St Thomas Street, London SE1 9RT, UK. loic.lang-lazdunski@gstt.nhs.uk
Objective:
To evaluate the efficacy and risks of autologous 'blood patch' pleurodesis in patients with persistent air leak after pulmonary resection.
Methods:
All patients operated on by a single surgeon between January 2002 and January 2004 and presenting with a persistent air leak after pulmonary resection have been treated by the autologous blood patch pleurodesis technique. Fifty millilitres of autologous blood were injected through the chest tube that was then rinsed, clamped for 30 min and then unclamped and placed back to water seal.
Results:
We have obtained a 100% success rate in 11 patients with persistent air leak who have been treated with this technique over a 2-year period. Most air leaks (72.7%) ceased within 12 h of blood injection. No patient developed empyema, but two patients developed fever and pleural fluid grew Staphylococcus after blood pleurodesis. At 3-month follow-up, all patients were well and their lungs were expanded fully.
Conclusions:
In our experience a single injection of 50 ml of blood is sufficient to seal persistent air leaks in less than 48 h. Although highly effective, the autologous blood patch pleurodesis technique should not be used in patients with incomplete lung re-expansion or positive pleural fluid culture to minimize the risk of empyema.
