Treatment Of Persistent Air Leak Following Lung Resections With Autologous Blood Patch Pleurodesis
VIJAYANT DEVENRAJ, SARVESH KUMAR, VIVEK TEWARSON, VED PRAKASH, AJAY KUMAR PANDEY.
KING GEORGE'S MEDICAL UNIVERSITY, LUCKNOW, India.
OBJECTIVE: Persistent air leak (PAL) after lung resections are most frustrating to manage for thoracic surgeons. We present 15 patients who underwent autologous blood patch pleurodesis for PAL following lung resections.
METHODS: Between January 2015 to July 2016, 64 patients underwent lung resections at our centre for various different pathologies. 15 patients (23.4%) had PAL of more than 5 days and broncho-pleural fistula grade 2 or less. On 6th pod , 2ml/kg body weight autologous blood was drawn from femoral vein and immediately introduced into intercostal chest tube with out any additives. The chest tube was connected to water seal and kept 60 centimeters above the patient chest and left unclamped. Patient was positioned in four different positions for 20 minutes each. After 48 hours of this procedure, with no clinically evident air leak the chest tube was clamped for 2 hours and chest x-ray done. If this showed no evidence of pneumothorax , the chest tube was removed. Follow up chest x-ray done at 14 days, 1 month and 3 months.
RESULTS: Within 24 hours of autologous blood instillation, the air leak stopped in 14 patients ( 93 %). One patient required second instillation after 24 hours. Another patient developed recurrence and required second instillation of autologous blood. Both these patients had complete cessation of air leak . In all, 13 patients ( 86%) had complete cessation of PAL following single instillation with chest tube removal at 48 hours. Two patients required second instillation resulting in complete cessation of air leak. No patient experienced pain, breathlessness ,fever or residual pleural effusion. On follow up , there was no evidence of pneumothorax or empyema.
CONCLUSIONS: Autologous blood patch pleurodesis for PAL following lung resections is safe, effective & easy bed-side procedure and allows for early chest tube removal. Autologous bood quantity of 2ml/kg body weight is effective.LEGEND : Procedure being performed bedside.
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