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Autologous blood pleurodesis for treating persistent air leak after lung resection

2001; Elsevier BV; Volume: 71; Issue: 4 Linguagem: Inglês

10.1016/s0003-4975(00)02689-8

1552-6259

Michael Shackcloth, Mike Poullis, Richard Page,

Lung Cancer Diagnosis and Treatment

We congratulate Rivas de Andrés and colleagues [1Rivas de Andrés J.J Blanco S de la Torre M Postsurgical pleurodesis with autologous blood in patients with persistent air leak.Ann Thorac Surg. 2000; 70: 270-272Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar] for bringing the technique of autologous blood pleurodesis for treatment of persistent air leak following lung resections to the attention of your readers. We would, however, like to suggest two modifications to their technique, and make everyone aware of a potentially serious complication of this procedure.When performing a blood pleurodesis, we suggest inserting a 3/8-inch leur lock connector in between the chest drain and drain tubing. The blood is taken from the patient in two 60-ml leur lock syringes and then injected via the 3/8-inch leur lock connector into the pleural cavity. Performing the blood pleurodesis this way decreases the risk of accidental spillage of blood and may reduce the chances of introducing infection into the pleural cavity.The second modification of the technique is the timing. We also advocate the use of blood pleurodesis at day 5, rather than leaving it to the 9th postoperative day as Rivas de Andrés suggests [1Rivas de Andrés J.J Blanco S de la Torre M Postsurgical pleurodesis with autologous blood in patients with persistent air leak.Ann Thorac Surg. 2000; 70: 270-272Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar]. There are two reasons for this. Firstly, if they have an air leak at day 5, the patient’s discharge is presumably delayed and, by performing the pleurodesis early, we hope to minimize the hospital stay. If the blood pleurodesis fails to seal the air leak within 48 hours, we repeat it. Secondly, the longer the chest drain is in situ, the greater the likelihood of colonization with bacteria and, hence, introduction of infection into the pleural space when performing blood pleurodesis.One potential complication of blood pleurodesis, that everybody should be aware of, is the risk of tension pneumothorax occurring due to blood clotting in the chest drain.In light of the reported success of blood pleurodesis, further randomized control trials are needed to ascertain the true value of this technique, the optimal volume of blood to inject, and the best time to perform blood pleurodesis. We congratulate Rivas de Andrés and colleagues [1Rivas de Andrés J.J Blanco S de la Torre M Postsurgical pleurodesis with autologous blood in patients with persistent air leak.Ann Thorac Surg. 2000; 70: 270-272Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar] for bringing the technique of autologous blood pleurodesis for treatment of persistent air leak following lung resections to the attention of your readers. We would, however, like to suggest two modifications to their technique, and make everyone aware of a potentially serious complication of this procedure. When performing a blood pleurodesis, we suggest inserting a 3/8-inch leur lock connector in between the chest drain and drain tubing. The blood is taken from the patient in two 60-ml leur lock syringes and then injected via the 3/8-inch leur lock connector into the pleural cavity. Performing the blood pleurodesis this way decreases the risk of accidental spillage of blood and may reduce the chances of introducing infection into the pleural cavity. The second modification of the technique is the timing. We also advocate the use of blood pleurodesis at day 5, rather than leaving it to the 9th postoperative day as Rivas de Andrés suggests [1Rivas de Andrés J.J Blanco S de la Torre M Postsurgical pleurodesis with autologous blood in patients with persistent air leak.Ann Thorac Surg. 2000; 70: 270-272Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar]. There are two reasons for this. Firstly, if they have an air leak at day 5, the patient’s discharge is presumably delayed and, by performing the pleurodesis early, we hope to minimize the hospital stay. If the blood pleurodesis fails to seal the air leak within 48 hours, we repeat it. Secondly, the longer the chest drain is in situ, the greater the likelihood of colonization with bacteria and, hence, introduction of infection into the pleural space when performing blood pleurodesis. One potential complication of blood pleurodesis, that everybody should be aware of, is the risk of tension pneumothorax occurring due to blood clotting in the chest drain. In light of the reported success of blood pleurodesis, further randomized control trials are needed to ascertain the true value of this technique, the optimal volume of blood to inject, and the best time to perform blood pleurodesis. Autologous blood pleurodesis for treating persistent air leak after lung resection: ReplyThe Annals of Thoracic SurgeryVol. 71Issue 4Preview Full-Text PDF