https://doi.org/10.4081/monaldi.2024.2994

Thoracoscopic blood patch instillation for persistent air leak in pneumothorax: a case series and systematic review

Early Access
Submitted: March 17, 2024
Accepted: March 22, 2024
Published: April 5, 2024
Thoracoscopy, persistent air leak, autologous blood patch pleurodesis, pneumothorax
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Authors

Yash Kedia
https://orcid.org/0000-0002-0453-0039
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, New Delhi, India.
Manu Madan
https://orcid.org/0000-0001-9245-4568
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Rajnish Kaushik
https://orcid.org/0009-0008-3985-4659
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Rohit Kumar
https://orcid.org/0000-0001-6398-7840
Department of Pulmonary Medicine, VMMC and Safdarjung Hospital, New Delhi, India.
AJ Mahendran
https://orcid.org/0000-0003-4907-1312
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Pranav Ish
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Neeraj Gupta
https://orcid.org/0000-0003-2776-0125
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Tanmaya Talukdar
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.
Nitesh Gupta
niteshgupta2107@gmail.com
https://orcid.org/0000-0002-5842-5584
Department of Pulmonary and Critical Care Medicine, VMMC and Safdarjung Hospital, Delhi, India.

Persistent air leaks in patients with pneumothorax can lead to significant morbidity. If a patient with persistent air leak is medically unfit for thoracic surgery, medical pleurodesis via chest tube or thoracoscopy is either an option. Thoracoscopy offers the advantage of visualizing the site of the air leak and enabling direct instillation of the pleurodesis agent or glue at that location. Autologous blood patch instillation via chest tube has been reported to be a cheap and very effective technique for the management of persistent air leaks. However, thoracoscopic blood patch instillation has not been reported in the literature. We report two cases of secondary spontaneous pneumothorax in which patients had persistent air leaks for more than seven days and were subjected to thoracoscopy to locate the site of the leak. In the same sitting, 50 mL of autologous blood patch was instilled directly at the leak site. Post-procedure, the air leak subsided in both patients, and the chest tube was removed with complete lung expansion. We also conducted a systematic review of the use of medical thoracoscopic interventions for treating persistent air leaks.

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Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of persistent air leaks. Chest 2017;152:417-23. DOI: https://doi.org/10.1016/j.chest.2017.02.020
Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society guideline for pleural disease. Thorax 2023;78:s1-42. DOI: https://doi.org/10.1136/thorax-2022-219784
Karampinis I, Galata C, Arani A, et al. Autologous blood pleurodesis for the treatment of postoperative air leaks. A systematic review and meta‐analysis. Thorac Cancer 2021;12:2648-54. DOI: https://doi.org/10.1111/1759-7714.14138
Cerfolio RJ. Advances in thoracostomy tube management. Surg Clin North Am 2002;82:833-48. DOI: https://doi.org/10.1016/S0039-6109(02)00026-9
Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590-602. DOI: https://doi.org/10.1378/chest.119.2.590
Lang-Lazdunski L, Coonar AS. A prospective study of autologous “blood patch” pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg 2004;26:897-900. DOI: https://doi.org/10.1016/j.ejcts.2004.07.034
Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428-9.
Ibrahim IM, Elaziz MEA, El-Hag-Aly MA. Early autologous blood-patch pleurodesis versus conservative management for treatment of secondary spontaneous pneumothorax. Thorac Cardiovasc Surg 2019;67:222-6. DOI: https://doi.org/10.1055/s-0038-1642028
Umar Z, Nassar M, Ashfaq S, et al. The efficacy and safety of autologous blood patch for persistent air leaks: a systematic review and meta-analysis. Cureus 2023;15:e36466. DOI: https://doi.org/10.7759/cureus.36466
Majeed FA, Khan YS, Raza A, et al. Video assisted thoracoscopic management of primary spontaneous pneumothorax. J Pak Med Assoc 2021;71:210-4.
Fung S, Kivilis M, Krieg A, et al. Video-assisted thoracoscopic surgery with bullectomy and partial pleurectomy versus chest tube drainage for treatment of secondary spontaneous pneumothorax-a retrospective single-center analysis. Medicina (Kaunas) 2022;58:354. DOI: https://doi.org/10.3390/medicina58030354
Lopez C, Facciolo F, Lequaglie C, et al. Efficacy and safety of fibrin sealant patch in the treatment of air leakage in thoracic surgery. Minerva Chir 2013;68:559-67.
Tschopp JM, Évéquoz D, Karrer W, et al. Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty. Chest 1990;97:745-6. DOI: https://doi.org/10.1378/chest.97.3.745
Tschopp JM, Brutsche M, Frey JG. Treatment of complicated spontaneous pneumothorax by simple talc pleurodesis under thoracoscopy and local anaesthesia. Thorax 1997;52:329-32. DOI: https://doi.org/10.1136/thx.52.4.329
Györik S, Erni S, Studler U, et al. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007;29:757-60. DOI: https://doi.org/10.1183/09031936.00122106
Holtzclaw A, McKay S, Mullenix P, Browning R. Novel treatment of a refractory alveolopleural fistula using medical pleuroscopy. J Bronchology Interv Pulmonol 2021;28:e4-7. DOI: https://doi.org/10.1097/LBR.0000000000000694
Zhang L, Xie T, Fu Y, Wu H. Assessment and review of treatment for secondary spontaneous pneumothorax using medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis. Ther Adv Respir Dis 2021;15: 1753466620986390. DOI: https://doi.org/10.1177/1753466620986390

How to Cite

Kedia, Yash, Manu Madan, Rajnish Kaushik, Rohit Kumar, AJ Mahendran, Pranav Ish, Neeraj Gupta, Tanmaya Talukdar, and Nitesh Gupta. 2024. “Thoracoscopic Blood Patch Instillation for Persistent Air Leak in Pneumothorax: A Case Series and Systematic Review”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2024.2994.
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