Blood Patch Pleurodesis: An Option in Persistent Air Leak for Patients With Advanced Lung Disease

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Procedures SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Structural lung diseases, such as idiopathic pulmonary fibrosis, can cause pneumothorax with the disease progression. Pneumothorax in this setting can be refractory and difficult to manage, as rigid lung parenchyma inhibits reexpansion, causing persistent air leak despite tube thoracostomy. Chemical pleurodesis may be an option in such cases, but is only effective if the lung expands after chest tube placement, and could actually worsen the underlying lung disease. The definitive treatment in this setting is surgical interventions like decortication. But due to poor respiratory reserve in advanced lung diseases, many patients are unable to tolerate surgery. Blood patch pleurodesis, first described by Dumire et al in 1992, is an option in these difficult patients.1 CASE PRESENTATION: 52-year-old non-smoker male with a history of advanced idiopathic pulmonary fibrosis presented with dyspnea, cough, and absent breath sounds on the right hemithorax. Imaging was consistent with right sided tension pneumothorax. He had two prior hospital admissions in the past two months for apparently unprovoked pneumothoraces, which required tube thoracostomies. A right sided chest tube was placed with immediate release of air and placed on suction. Attempts to taper down the suction over subsequent days were unsuccessful, and the patient’s respiratory status was too tenuous for definitive surgical intervention. Autologous blood patch pleurodesis was performed on day nine. Patient tolerated the procedure well and chest tube could be removed over the next few days. DISCUSSION: At previous studies, the median survival time after the first episode of pneumothorax was less than nine months in patients with idiopathic interstitial pneumonia.2 Even after tube thoracosentesis, frequently lung does not reexpand and there may be a persistent air leak. Oftentimes these patients’ respiratory reserves are inadequate to tolerate anesthesia, single lung ventilation, or other surgical interventions. In these difficult patients, blood patch pleurodesis is a relatively safe bedside procedure with reasonably effective results. Previous studies on use of blood patch pleurodesis show comparable results to chemical pleurodesis,2 and increasing effectiveness with subsequent procedures.3 CONCLUSIONS: Blood patch pleurodesis is an option for persistent air leak in patients with advanced lung disease. Reference #1: Dumire R, Crabbe MM, Mappin FG, Fontenella LJ. Autologous ‘blood patch’ pleurodesis for persistent pulmonary air leak. Chest 1992; 101: 64-66. Reference #2: Aihara et al. Efficacy of Blood-Patch Pleurodesis for Secondary Spontaneous Pneumothorax in Interstitial Lung Disease. Intern Med 2011; 50:1157. Reference #3: Ando et al. Autologous blood-patch pleurodesis for secondary spontaneous pneumothorax with persistent air leak. Respir Med. 1999 Jun;93(6):432-4. DISCLOSURE: The following authors have nothing to disclose: Selma Demir, Pavan Gorukanti, Sushilkumar Gupta, Mangalore Amith Shenoy, Amit Agarwal, Pavan Irukulla, William Pascal No Product/Research Disclosure Information