https://doi.org/10.4081/monaldi.2022.2036

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

http://commons.wikimedia.org/wiki/User:BruceBlaus
Vol. 92 No. 4 (2022)
Submitted: July 29, 2021
Accepted: March 3, 2022
Published: June 10, 2022
Autologous blood patch pleurodiesis, Secondary spontaneous pneumothorax, persistent airleak
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Authors

Vijayarangam Narenchandra
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Govindaraj Vishnukanth
vishnu1429@yahoo.com
https://orcid.org/0000-0002-3854-2388
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Dharm Prakash Dwivedi
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Munuswamy Hemachandren
Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Subathra Adithian
Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Saka Vinod Kumar
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Manju Rajangam
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Madhusmita Mohanty Mohapatra
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Pratap Upadhya
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

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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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). https://doi.org/10.4081/monaldi.2022.2036.
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