Autologous Blood Patch Pleurodesis for Secondary Spontaneous Pneumothorax: A Narrative Review, a Retrospective Case Series and State of Play in the UK

Sufyan Shakir; Brian Choo-Kang; Clare Ross; Kevin Conroy; Richard Thorley; Steven Walker; Rahul Bhatnagar; Avinash Aujayeb

doi:10.1007/s41030-022-00212-w

Autologous Blood Patch Pleurodesis for Secondary Spontaneous Pneumothorax: A Narrative Review, a Retrospective Case Series and State of Play in the UK

Pulm Ther. 2023 Mar;9(1):165-172. doi: 10.1007/s41030-022-00212-w. Epub 2022 Dec 30.

Authors

Sufyan Shakir¹, Brian Choo-Kang², Clare Ross³, Kevin Conroy⁴, Richard Thorley⁵, Steven Walker⁶, Rahul Bhatnagar⁶, Avinash Aujayeb⁷

Affiliations

¹ Department of Respiratory Medicine, Northumbria Healthcare NHS Trust, Northumbria Way, Cramlington, NE23 6NZ, UK.
² Department of Respiratory Medicine, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
³ Imperial College NHS Trust, Exhibition Rd, South Kensington, London, SW7 2BX, UK.
⁴ North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Hardwick Road, Stockton On Tees, Cleveland, TS19 8PE, UK.
⁵ Departement of Respiratory Medicine, North Devon District Hospital, Raleigh Heights, Barnstaple, EX31 4JB, UK.
⁶ Academic Respiratory Unit, 2nd Floor, Learning and Research, Southmead Hospital, Westbury-On-Trym, Bristol, BS10 5NB, UK.
⁷ Department of Respiratory Medicine, Northumbria Healthcare NHS Trust, Northumbria Way, Cramlington, NE23 6NZ, UK. avinash.aujayeb@nhct.nhs.uk.

Abstract

Introduction: Treatment of prolonged air leak due to secondary spontaneous pneumothorax is challenging. Autologous blood patch pleurodesis (ABPP) is a treatment option. Previous evidence is reliant on single-centre series and underpowered trials and is mostly described in air leaks post cardiothoracic intervention. There are no United Kingdom (UK) wide data.

Methods: Members of the UK Pleural Society were surveyed for their practice and for patients who underwent blood patch. There were 16 respondents from 333 members. Twelve had performed the procedure, and six had kept records and could submit data. Basic demographics, intervention and clinical details of patients were then collected. The study was sponsored by the Audit Department of Northumbria Healthcare NHS Foundation Trust (reference 8124), and Caldicott Clearance for data sharing was provided by the Trust's Information Goverance Board (reference C4221). There was no requirement for informed consent.

Results: Data for 12 patients that received ABPP between 2014 and 2022 in six respiratory centres were assessed. The aetiology of the secondary pneumothoraces was mostly due to chronic obstructive pulmonary disease and end-stage interstitial lung disease. The patients had a median age of 75 years. The median air leak time before ABPP was 17 days. A total of 50-100 ml of blood was used for ABPP. Five patients had two attempts at ABPP. Air leak resolved in six patients (50%). Four patients had pleural apposition prior to ABPP. Four patients were diagnosed with hospital-acquired pneumonia following ABPP.

Conclusion: This is the only UK-wide retrospective case series of ABPP of 'medical' patients with secondary pneumothorax. There is widespread variation in care. No formal conclusions can be drawn, and much larger robust datasets are required. An application has been made to the European Respiratory Society to incorporate ABPP within the International Collaborative Effusion database.

Keywords: Autologous blood patch; Blood patch; Pleurodesis; Pneumothorax.