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Eur J Cardiothorac Surg 2005;27:935
© 2005 Elsevier Science NL

Letter to the Editor

An alternative to drain clamping for blood pleurodesis

Nicola C. Jones*, Philip Curry, Alan J.B. Kirk

Department of Cardiothoracic Surgery, Western Infirmary, Glasgow, Level 9 Cardiothoracic Surgery, G11 Glasgow, UK

Received 10 January 2005; accepted 21 January 2005.

* Corresponding author. Tel.: +44 141 2112190. (E-mail: nc.jones{at}btinternet.com).

Key Words: Chest drains • Pleurodesis • Persistent air leak

We read with interest the paper ‘A Prospective study of autologous ‘Blood patch’ pleurodesis for persistent air leak after pulmonary resection’ by Loïc Lang-Lazdunski and Aman S. Coonar (Eur J Cardiothorac Surg 26 (2004) 897–900) [1]. We too would endorse the use of autologous blood patch pleurodesis for persistent air leak. It is effective and economic as a treatment in this group of patients. In our unit, we use this technique after 4 days of persistent air-leak as we have found that if the air-leak has not resolved by day four, it is unlikely to do so by day 7 without further intervention. We also used to inject 50–60ml of autologous blood, but with poor efficacy, unlike the authors. We now use a total of 120ml instilled once. This has resulted in close to one hundred percent resolution of air leaks and is consistent with previous studies [2–4].

However, we would raise one concern with regard to the methodology of performing blood patch pleurodesis. In our experience, these patients have a significant air-leak and would not tolerate the drain being clamped at all, let alone for 30min as suggested by the authors. Such patients are at risk of developing a tension pneumothorax. We would advise instead that the chest tube is rigged up on a drip stand (Fig. 1). This allows the autologous blood patch to remain within the chest cavity, but enables any air to ‘escape’, with minimal risk of developing a tension pneumothorax. We would therefore recommend this technique as an alternative to clamping.



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  		Fig. 1. Chest drain is hooked up over a drip-stand, allowing air to escape whilst the blood pleurodesis remains within the chest.

 

Footnotes

{star} The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.

References

  1. 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.[Abstract/Free Full Text]
  2. Rivas de Andres JJ, Blanco S, Dela Torre M. Postsurgical pleurodesis with autologous blood in patients with persistent air leak. Ann Thorac Surg 2000;70:270-272.[Abstract/Free Full Text]
  3. Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428-429.[Medline]
  4. Shackcloth MJ, Poullis M, Jackson M, Soorae AS, Drakeley MJ, Page RD. Intrapleural instillation of autologous blood for prolonged air leaks following lobectomy—a prospective randomised trial. Presented at 16th Annual Meeting of the European Association for Cardio-thoracic Surgery Sep 2002..



This article has been cited by other articles:


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C. Andreetti, F. Venuta, M. Anile, T. De Giacomo, D. Diso, M. Di Stasio, E. A. Rendina, and G. F. Coloni
Pleurodesis with an autologous blood patch to prevent persistent air leaks after lobectomy
J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 759 - 762.
[Abstract] [Full Text] [PDF]

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