Comparison of efficacy of autologous blood patch pleurodesis versus doxycycline pleurodesis in the management of persistent air leak in patients with secondary spontaneous pneumothorax. A randomized controlled trial
Submitted: July 29, 2021
Accepted: March 3, 2022
Published: June 10, 2022
Abstract Views: 1709
PDF: 575
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Secondary spontaneous pneumothorax (SSP) patients sometimes have a persistent air leak (PAL) that leads to increased morbidity and increased hospital stay. Further, these patients also need pleurodesis to prevent a recurrence. Autologous blood patch pleurodesis (ABPP) has been successfully tried in post-lobectomy air leak cases. However, its utility in SSP patients with PAL has not been widely established. In this context, we performed a non-blinded randomized control study to compare the efficacy of ABPP vs doxycycline pleurodesis in the closure of air leak in SSP patients. This study was a non-blinded randomized control study done in 38 SSP patients with PAL. They were randomized into doxycycline arm and ABPP arm. Post pleurodesis air leak was assessed every 12 hours for cessation. Success was considered when there was a complete cessation of air leak. Post-procedural complications were noted and patients were followed up for 28 days to look for recurrence. The median time for closure was 24 hours [interquartile range (12.24)] for ABPP and 36 hours [interquartile range (24.72)] for doxycycline pleurodesis. Success rate of ABPP vs doxycycline pleurodesis is 94.7% vs 84.2% (p=0.6). Post-procedure pain was more in doxycycline group (15% vs 73%) (p<0.01). On visual analogue scale, ABPP had a lesser pain as compared to doxycycline pleurodesis (average visual analogue scale value of 2 vs scale of 7). The recurrence rate was equal in both groups (5%). Though ABPP and doxycycline have similar success rates, ABPP has an early closure of air leak and greater patient tolerability. ABPP can be tried as an alternative to doxycycline pleurodesis in SSP patients with persistent air leaks.



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Noppen M, Spontaneous pneumothorax: epidemiology, pathophysiology and cause. Eur Respir Rev 2010;19:117:217–9. DOI:
Lazarus DR, Casal RF. Persistent air leaks: a review with an emphasis on bronchoscopic management. J Thorac Dis 2017;9:4660–70. DOI:
Dumire R, Crabbe MM, Mappin FG, Fontenelle LJ. Autologous “blood patch” pleurodesis for persistent pulmonary air leak. Chest 1992;101:64–6. DOI:
Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural instillation of autologous blood in the treatment of prolonged air leak after lobectomy: A prospective randomized controlled trial. Ann Thorac Surg 2006;82:1052–6. DOI:
Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428–9.
Cagirici U, Sahin B, Cakan A, et al. Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. Scand Cardiovasc J 1998;32:75–8. DOI:
Martínez-Escobar S, Ruiz-Bailén M, Lorente-Acosta MJ, et al. Pleurodesis using autologous blood: a new concept in the management of persistent air leak in acute respiratory distress syndrome. J Crit Care 2006;21:209–16. DOI:
Cobanoglu U, Melek M, Edirne Y. Autologous blood pleurodesis: A good choice in patients with persistent air leak. Ann Thorac Med 2009;4:182. DOI:
Khan MA, Bhat MA, Majeed A, et al. Intrapleural therapy for the prevention of recurrent spontaneous pneumothorax-A randomized comparative evaluation of bleomycin pleurodesis & autologous blood pleurodesis. Int J Adv Res Ideas Innov Technol 2017:3;955-9.
Heffner JE, Unruh L, Standerfer RJ, Torstveit J. Clinical efficacy of doxycycline for pleurodesis. Chest 1994;105:1743–7. DOI:
Cerfolio RJ. Recent advances in the treatment of air leaks. Curr Opin Pulm Med 2005;11:319–23. DOI:
MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010.Thorax 2010;65:ii18-ii31. DOI:
Onuki T, Ueda S, Yamaoka M, et al. Primary and secondary spontaneous pneumothorax: Prevalence, clinical features, and in-hospital mortality. Can Respir J 2017;2017:6014967. DOI:
Hobbs BD, Foreman MG, Bowler R, et al. Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014;11:1387–94. DOI:
Droghetti A, Schiavini A, Muriana P, et al. Autologous blood patch in persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg 2006;132:556–9. DOI:
Abu Arab W, Ramadan A. Spontaneous pneumothorax associated with primary lung cancer: a retrospective study. Cardiothor Surg 2020;28:10. DOI:
Grosu HB, Vial MR, Hernandez M, et al. Secondary spontaneous pneumothorax in cancer patients. J Thorac Dis 2019;11:1495–505. DOI:
de Andrade FM, Pereira MR, Kilesse RL, Dos Santos Barnetano B. Autologous blood patch pleurodesis: An effective but underused method. Lung India 2018;35:34142. DOI:
Iwasawa T, Ogura T, Takahashi H, et al. Pneumothorax and idiopathic pulmonary fibrosis. Jpn J Radiol 2010;28:672–9. DOI:
Ozpolat B. Autologous blood patch pleurodesis in the management of prolonged air leak. Thorac Cardiovasc Surg 2010;58:52–4. DOI:
Chambers A, Routledge T, Billè A, Scarci M. Is blood pleurodesis effective for determining the cessation of persistent air leak? Interact Cardiovasc Thorac Surg 2010;11:468-72. DOI:
Rivas de Andrés JJ, Blanco S, de la Torre M. Postsurgical pleurodesis with autologous blood in patients with persistent air leak. Ann Thorac Surg 2000;1:270-2. DOI:
Read CA, Reddy VD, O’Mara TE, Richardson MSA. Doxycycline pleurodesis for pneumothorax in patients with AIDS. Chest 1994;105:823–5. DOI:
Muruganandan S, Kumar S, Lee YCG. Blood patch for pneumothorax: a literature review. Curr Pulmonol Rep 2017;6:30-8. DOI:

How to Cite

Narenchandra, Vijayarangam, Govindaraj Vishnukanth, Dharm Prakash Dwivedi, Munuswamy Hemachandren, Subathra Adithian, Saka Vinod Kumar, Manju Rajangam, Madhusmita Mohanty Mohapatra, and Pratap Upadhya. 2022. “Comparison of Efficacy of Autologous Blood Patch Pleurodesis <em>versus</em> Doxycycline Pleurodesis in the Management of Persistent Air Leak in Patients With Secondary Spontaneous Pneumothorax. A Randomized Controlled Trial”. Monaldi Archives for Chest Disease 92 (4).