Intrapleural Instillation of Autologous Blood for Persistent Air Leak in Spontaneous Pneumothorax in Patients With Advanced Chronic Obstructive Pulmonary Disease

Ann Thorac Surg. 2012 May;93(5):1652-7. doi: 10.1016/j.athoracsur.2012.01.093. Epub 2012 Mar 28.

Abstract

Background: We evaluated the safety and efficacy of increasing doses of autologous blood patch pleurodesis in treating persistent air leaks in patients with advanced chronic obstructive pulmonary disease (COPD).

Methods: Forty-four patients with COPD and spontaneous pneumothorax (SP) on the 7th day after intercostal tube drainage were randomly assigned to 4 groups, with 11 patients in each group. Groups A, B, and C were given increasing doses of autologous blood--ie, 0.5 mL/kg, 1 mL/kg, 2 mL/kg, respectively--whereas group D was given 1 mL/kg normal saline only. The procedure was repeated if the air leak persisted on postoperative days 9 and 11. Patients in group D crossed over and received autologous blood as in group B if the air leak was still present on the 13th postoperative day.

Results: No patient died in the study. The air leak was sealed by the 13th postoperative day only in patients with air leaks smaller than size 3. Air leaks were classified as 0 to 3 [12], ie, size 0=no air leak; size 1=air leak on vigorous coughing only; size 2=small continuous air leak on gentle respiration; and size 3=large continuous air leak on gentle respiration. The success rates by the 13th postoperative day in groups A, B, C, and D were 27%, 82%, 82%, and 9%, respectively. The success rate (82%) was significantly higher in groups B and C than in group A (p=0.003) and D (p>0.01).

Conclusions: Using autologous blood to treat secondary spontaneous pneumothorax (SSP) in patients with advanced COPD is easy, safe, and effective. The dose of blood required for autologous blood patch pleurodesis should be dependent on the body weight, and 1 mL/kg blood may be efficient.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Blood Transfusion, Autologous / methods*
  • Chest Tubes
  • Drainage / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Instillation, Drug
  • Male
  • Middle Aged
  • Pleurodesis / methods*
  • Pneumothorax / diagnostic imaging
  • Pneumothorax / etiology
  • Pneumothorax / therapy*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Radiography, Thoracic / methods
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome