Pleurodesis by autologous blood: a new concept in the management of persistent air leak in acute respiratory distress syndrome

Introduction

Pneumothorax is present in 48.8% of cases of acute respiratory distress syndrome (ARDS), its development becomes more likely as the duration of the process increases and its presence affects the patient's chances of survival. Bronchopleural fistulas prolong pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. No prospective controlled studies have been carried out into the management of persistent air leak (PAL) in ARDS, nor has any therapeutic option for its treatment been proved superior to another. Pleurodesis by autologous blood (PAB) is an effective, simple and inexpensive method in a select number of cases of oncological pulmonary surgery; also, there are anecdotal descriptions of its use with nonsurgical patients.

Objective

The goal of this study is to compare the efficacy of PAB with the conventional continuous aspiration in the management of PAL in ARDS patients with pneumothorax.

Design

A nonrandomized study comparing two groups undergoing artificial pairing 1:1.

Patients

Two groups of 17 patients all with ARDS, pneumothorax and PAL.

Interventions

One group had undergone conventional treatment while the other received PAB.

Results

The average difference between the groups is 8 days less seal time (P < 0.001), 11 days less weaning time (P < 0.001), and 9 days less, on average, time spent in ICU (P < 0.001).

Conclusions

The use of PAB in comparison with the exclusive use of a thoracic drain with a water seal for the treatment of PAL in ARDS is an effective, inexpensive and simple method that decreases the ventilator weaning time and makes for a shorter stay in the ICU.

Table 1 The increase between day 1 and day 7 of respiratory values of studies