How to Do ItAutoblood Plus OK432 Pleurodesis With Open Drainage for Persistent Air Leak After Lobectomy
Section snippets
Patients and Methods
From January 1996 to February 1997, 10 consecutive patients who underwent lobectomy for lung cancer were treated by blood OK432 pleurodesis because of persistent air leakage (Table 1). In all cases, we tried several procedures (decreasing, increasing, or stopping chest suction) before pleurodesis. In principle, patients with persistent air leak longer than 1 week (8.7 ± 4.7 days) were treated. In 4 patients, prior therapies (tetracycline, OK432, and another pleurodesis) were tried but failed.
Results
Blood OK432 pleurodesis was done once in 6 patients and twice in 4 patients (see Table 1). In all patients, successful treatment of the air leak was achieved within few days (mean, 3.8 ± 2.0 days). The air leak actually stopped 1 to 2 days after pleurodesis in most patients. The chest tube was removed 1 to 2 days after the confirmation of no air leak. No major side effects were observed. In 5 patients, fever of less than 38°C was observed.
In patient 1, presented as an example, obliteration of
Comment
Air leak after lobectomy usually ceases spontaneously if adequate reexpansion of the remaining lung is established. Even if a prolonged air leak occurs, pleurodesis with sclerosing agents such as tetracycline, talc, or OK432 may work 1, 2, 3. However, chemical pleurodesis often fails to work if persistent air leak with dead space remains. Furthermore, without adequate reexpansion, the sclerosing agent itself may prevent reexpansion of the remaining lung because of thickening of the visceral
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Cited by (27)
Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial
2018, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :If an air leak was suspected, the chest tube was removed after a 24-hour chest tube clamping trial. Among patients with air leaks continuing for ≥ 5 days, pleurodesis via intrathoracic administration of the sclerosing agent OK432 with or without 50 mL autologous blood through the chest tube was performed according to the clinical judgment of the attending physician for each patient.13 The duration of chest tube placement in group T was defined as 4.5 ± 2.52 days.12
Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System
2017, Annals of Thoracic SurgeryCitation Excerpt :The chest tubes were removed when the air leakage rate was less than 20 mL/min for more than 12 hours and the amount of pleural effusion drainage was 300 mL/day or less. Among patients with air leaks continuing for 5 or more days, pleurodesis by intrathoracic administration of the sclerosing agent OK-432, with or without 50 mL of autologous blood through the chest tube, was performed according to the clinical judgment of the attending doctor for each patient [9]. Table 1 reports patient characteristics, Table 2 reports intraoperative findings, and Table 3 reports postoperative findings.
Evidence-Based Suggestions for Management of Air Leaks
2010, Thoracic Surgery ClinicsCitation Excerpt :An antibiotic such as doxycycline may thus be preferable for pleurodesis in this scenario. Autologous blood patch is another nonsurgical option to treat prolonged or persistent ALs following operation or spontaneous pneumothorax.68–73 Blood-patch pleurodesis involves the instillation of autologous blood into the pleural space through a chest catheter.
Management of Alveolar Air Leaks After Pulmonary Resection
2010, Annals of Thoracic SurgeryCitation Excerpt :It is simple, relatively painless, and often effective, but some information suggests that blood-patch pleurodesis may also carry an increased risk of intrathoracic infection [45, 46]. Although there are six articles on this subject [41–46], it is difficult to draw definitive conclusions due to the variable study sizes (from 2 patients [44] to 32 patients [45]), quantity of blood injected (50 to 150 mL), and endpoint definitions. It may be that the infection rate will be higher if the blood patch is used after Heimlich or other valved device has been in place for some weeks.
Autologous blood patch in persistent air leaks after pulmonary resection
2006, Journal of Thoracic and Cardiovascular Surgery