Autologous Blood Patching to Mitigate Persistent Air Leaks Following Pulmonary Resection: A Novel Approach

Abstract

BackgroundAutologous blood patch (ABP) utilized as a visceral pleural sealant for air leak post lung resection has been well documented in medical literature.PurposeTo present our experience of a novel approach, we employed to instill autologous blood into the pleural space to mitigate persistent air leaks following pulmonary resection.MethodsFrom January 2007 to September 2011, 19 patients were submitted to autologous blood patching for persistent air leaks following surgery. Demographic and surgical characteristics were collected at baseline. Blood patching measures were recorded at the time of the event. Continuous variables were summarized with median and range while categorical measures were summarized with frequency and percent. Due to the small sample size and descriptive nature of this study, no hypothesis tests were performed. All analyses were conducted using R Statistical Software. ResultsThe median age of patients who required a blood patch for a persistent air leak was 67.9 (Range: 50.3-78.7) years and 11 (57.9%) were males and 8 (42.1%) were females. The majority (78.9%) of the patients’ first surgery was mass resection and 4 (21.1%) had a lung volume reduction. Seven (36.7%) required a re-do surgery, and almost all (89.5%) had 28 mm chest tubes used during surgery. The majority or 63.2% (N=12) of the patient's air leaks were classified as moderate, 21.1% (N=4) as severe, 15.8% as mild (N=3); twelve (63.2%) required one attempt for a successful blood patch, 6 (31.6%) required two attempts, and one (5.3%) required three which were all unsuccessful. The median number of days from detecting air leaks to blood patch for the air leak that required two attempts was 9 (Range: 8, 23) days for lung volume reduction patients and 16 (Range: 6, 26 ) days for mass resection patients.ConclusionBlood patching remains an effective bedside strategy that can be carried out with minimal risk. We believe opportunities exist to further advance the method of delivering blood as an autologous sealant to mitigate persistent air leaks (PAL).