Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

2021 ◽  
Author(s):  
Alessio Campisi ◽  
Andrea Dell'Amore ◽  
Yonghui Zhang ◽  
Zhitao Gu ◽  
Angelo Paolo Ciarrocchi ◽  
...  
Keyword(s):  
Chest Tube ◽  
Autologous Blood ◽  
Optimal Time ◽  
Time Interval ◽  
Air Leak ◽  
Increased Risk ◽  
Tube Removal ◽  
Blood Patch ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

scholarly journals Safety of early discharge with a chest tube after pulmonary segmentectomy

2020 ◽  
Vol 58 (3) ◽  
pp. 613-618
Author(s):  
Feichao Bao ◽  
Natasha Toleska Dimitrovska ◽  
Shoujun Hu ◽  
Xiao Chu ◽  
Wentao Li
Keyword(s):  
Chest Tube ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Early Discharge ◽  
Air Leak ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Life Threatening ◽  
Chest Tube Removal ◽  
Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

scholarly journals What Keeps Postpulmonary Resection Patients in Hospital?

2003 ◽  
Vol 10 (2) ◽  
pp. 86-89 ◽  
Author(s):  
T Bardell ◽  
D Petsikas
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Chest Tube ◽  
Pulmonary Resection ◽  
Linear Regression Analysis ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

BACKGROUND: Prolonged air leak (longer than three days) was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS) was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.DESIGN: Retrospective review of 91 patients. Primary reasons for prolonged hospitalization were determined. Patient characteristics (demographic information, pulmonary function test results, body habitus measurements, smoking history), operative factors (procedure performed, duration of operation, complications) and postoperative factors (time of chest tube removal) were considered. Student'sttest andX2analysis were used to compare continuous and ratio data, respectively, and linear regression analysis was used to define the equation relating two variables.RESULTS: The mean postoperative LOS was 6.4 days. Only prolonged air leak was predictive of increased LOS (9.4 days versus 5.4 days, P<0.001). Forced expiratory volume in 1 s less than 1.5 L/min, carbon monoxide diffusing capacity less than 80% predicted and the detection of a pneumothorax were all predictive of prolonged air leak. A strong correlation between the time of chest tube removal and LOS was found (r=0.937, P<0.001). Linear regression analysis showed postoperative LOS and duration of thoracostomy tube insertion to be related by the equation y = 0.88x + 2.49 days.CONCLUSIONS: These results suggest that increased LOS following pulmonary resection is due primarily to prolonged air leaks. Furthermore, patients who have their chest tubes removed sooner are discharged sooner.

scholarly journals Intrabronchial Valve Treatment for Prolonged Air Leak: Can We Justify the Cost?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Eitan Podgaetz ◽  
Felix Zamora ◽  
Heidi Gibson ◽  
Rafael S. Andrade ◽  
Eric Hall ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Cost Effective ◽  
Air Leak ◽  
Levels Of Care ◽  
Air Leaks ◽  
Limited Experience ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal ◽  
The Cost

Background.Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks.Objective.To analyze our experience with IBV and valuate its cost-effectiveness.Methods.Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data.Results.We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900.Conclusion.In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

Therapeutic Pneumoperitoneum: Relevant or Obsolete in 2015?

2016 ◽  
Vol 65 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Jonathan Berger ◽  
Joe Small ◽  
Rafael Garza ◽  
Rafael Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Chest Tube ◽  
Pulmonary Function Tests ◽  
Vital Signs ◽  
Pleural Space ◽  
Abdominal Incision ◽  
Intraperitoneal Pressure ◽  
Proper Patient Selection ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who underwent TP from January 1, 2007, to January 1, 2015, were reviewed after Institutional Review Board approval. We report indication, preprocedure pulmonary function tests, volume of insufflated air, time to chest tube removal, and complications. We place a red rubber catheter into the peritoneal space through the diaphragm or a small abdominal incision, insufflate with room air, record volume (liters), intraperitoneal pressure (goal 9–10 mm Hg), and monitor vital signs, airway pressures, and urine output. Results We performed TP in 32 patients. Follow-up was available for 31 patients. Indications were prevention of pleural space problems in bilobectomy patients (n = 11), following decortication for empyema (n = 11), prevention of prolonged air leak (n = 3), prevention of postresection space (n = 4), and spontaneous chylothorax (n = 2). TP was done postoperatively in three patients. Median air volume used was 3.5 L (3–6 L). Time to chest tube removal overall was 7.8 days (3–20 days) and to discharge 10.2 days (4–32 days). No patient developed respiratory failure, renal failure, or required evacuation of TP. Conclusion TP is a simple, safe, and effective technique to manage pleural space problems. Proper patient selection and meticulous technique are imperative for the successful clinical application of TP. We believe that TP is an underutilized tool for the management of pleural space problems and merits wider application in thoracic surgical practice.

Efficacy of an autologous blood patch for prolonged air leak, a systematic review

2021 ◽  
Author(s):  
Niek Hugen ◽  
Edo J. Hekma ◽  
Niels J.M. Claessens ◽  
Hans J.M. Smit ◽  
Michel M.P.J. Reijnen
Keyword(s):  
Systematic Review ◽  
Autologous Blood ◽  
Air Leak ◽  
Blood Patch ◽  
Prolonged Air Leak

scholarly journals Postoperative Air Leaks With Prompt Improvement of Low Suction on Digital Drainage Devices: a Retrospective Study

2020 ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Maximum Amount ◽  
Fluid Volume ◽  
Suction Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Purpose: The aim was to investigate the most effective suction pressure for preventing or promptly improving postoperative air leaks.Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection between December 2017 and June 2020. We divided the patients into 3 of group by suction pressure, A (Low-pressure suction group: -5 cm H₂O), B (Intermediate-pressure group: -10 cm H₂O), C (High-pressure suction group: -20 cm H₂O). Duration of air leaks, duration of chest tube replacement, the amount of postoperative air leak, fluid volume drained before chest tube removal, and the maximum amount of air leaks during drainage were evaluated.Results: A total 217 patients were included. In the order of A, B, and C groups, duration of air leaks gradually decreased and significant trend was observed (p=0.019). Duration of chest tube replacement did not significantly differ among the three groups (p=0.126). The amount of postoperative air leak just after surgery did not significantly differ among the three groups (p=0.175), however, the amount of postoperative day 1 air leak gradually decreased with statistical significance in order of A, B, and C groups (p=0.033). The maximum amount of air leaks during drainage gradually decreased in order of A, B and C groups (p=0.036). Fluid volume drained before chest tube removal did not significantly differ among the three groups (p=0.986).Conclusion: Low-pressure suction after pulmonary resection would be useful for preventing or promptly improving postoperative air leaks.

scholarly journals Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

2019 ◽  
Vol 18 (4) ◽  
pp. 239-245
Author(s):  
Matas Mongirdas ◽  
Audrius Untanas ◽  
Žymantas Jagelavičius ◽  
Ričardas Janilionis
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
First Episode ◽  
Air Leak ◽  
Removal Time ◽  
Tube Removal ◽  
Significant Difference ◽  
Chest Tube Removal

Background / objectives. The main treatment option for the first episode of primary spontaneous pneumothorax is chest tube drainage, however, whether delayed chest tube removal might influence the recurrence is unclear.Methods. A prospective study, which included 50 patients, with an initial episode of primary spontaneous pneumothorax was performed. Patients were randomized into two groups according to the chest tube removal time: 1-day and 5-days after the air-leak has stopped. All patients were followed-up for at least six months. Both groups were compared according to the recurrence rate and possible complications.Results. There were 39 (78%) men and the median age was 27 (23–35) years. Successful management with a chest tube was achieved in 43 (86%) patients, others were operated on because of the continuous air-leak or relapse of the pneumothorax after the chest tube was removed. Significant difference was not found comparing groups by age, gender, side, tobacco smoking, alpha-1-antitrypsin level, rate of prolonged air-leak, necessity of surgery, and the mean follow-up time. There was a significant difference between groups in hospitalization time: 1-day group – 6 (4–12), 5-days group – 8 (7–10) days, p = 0.017. Five (20%) patients from 1-day group and 3 (12%) from 5-days group had a recurrence, however the difference was not significant (p = 0.702). There were no significant differences comparing groups by the recurrence time or complications.Conclusions. The recurrence rate of primary spontaneous pneumothorax was higher if the chest tube was removed earlier, however not significantly. More data and longer follow-up are necessary to confirm these findings.

scholarly journals Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial

2010 ◽  
Vol 37 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Alessandro Brunelli ◽  
Michele Salati ◽  
Majed Refai ◽  
Luca Di Nunzio ◽  
Francesco Xiumé ◽  
...  
Keyword(s):  
Chest Tube ◽  
Randomised Trial ◽  
Air Leak ◽  
Prospective Randomised Trial ◽  
Tube Removal ◽  
Chest Tube Removal
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