Autologous Blood Patch Pleurodesis: A Reliable Treatment Option For Prolonged Air Leakage in Children

Abstract

Objective: Persistent air leaks remain one of the most complications that delay chest tube removal and prolonged hospitalization. In literature, there are limited but favorable results about autologous blood patch pleurodesis (ABPP) for prolonged air leaks (PAL). We aimed to describe our experiences with ABPP for PAL regarding its effectiveness and reliability in children. Material and Methods: A retrospective single-center study was performed on patients under 18 years of age with PAL. PAL was defined as the presence of alveolar-pleural fistulas lasting longer than 5 days. The etiological causes including previous thoracic surgery, thoracic trauma, and spontaneous pneumothorax of PAL were included. The study took into account patients from January 1, 2016, to December 1, 2021. Autologous blood patch pleurodesis (ABPP) was performed through a pre-existing chest tube. 1-2 cc/kg of fresh whole blood that was taken from a peripheral vein and instilled through the existing chest tube on day 1. The procedure was repeated on days 2 and 4 if the air leak persisted with a maximum limit of three. During the follow-up period, complications of the procedure were evaluated. Complete success was considered as resolving air leaks. Results: Of 11 children, males were more common (n=7, 63.9%). The mean age of children who underwent ABPP for PAL was 13.4 2.1 years (IQR 10-17). The mean number of repeating procedures was 1.8 ranging from 1 to 3 applications. In our study group, thoracic procedures secondary to spontaneous pneumothorax were the most common etiologic cause. Most of the patients had PAL during forced expiration only (n=6, 54.5%), and the mean number of ABPP applications was found 1.7 in this group. But the patients having continuous PAL required 3.1 applications for improvement (mean value). Complete recovery was possible in six cases after the first application (54.5%). PAL improved in all cases after repeating ABPP procedures (100% healing). We had seen no complications in terms of respiratory distress due to the application of ABPP or infection. Conclusion: We report about our experiences of autologous blood patch pleurodesis (ABPP) in children as an alternative treatment option for PAL. ABPP is an easily applicable therapy with high effectiveness and being away from complications and, the use of ABPP for PAL was successful in all patients of our series.