Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Clinical Investigations Respiration 2010;79:302–306 DOI: 10.1159/000226277 Persistent Pleuropulmonary Air Leak Treated with Autologous Blood: Results from a University Hospital and Review of Literature Frederico H.S. Oliveira Daniele C. Cataneo Raul L. Ruiz, Jr. Antonio J.M. Cataneo Thoracic Surgery Discipline of the Surgery and Orthopedics Department, Botucatu School of Medicine, São Paulo State University, São Paulo, Brazil Introduction Persistent pleuropulmonary air leaks are extremely distressing to the thoracic surgeon. Their origin can be classified as primary spontaneous pneumothorax (with- out coexisting pulmonary disease) or secondary (associ- ated with underlying pathology) [1]. The latter is very common and difficult to manage. There are several pro- cedures for treating persistent air leak, the most suitable being chosen on a patient-by-patient basis. Different types of sclerosant used in pleurodesis [2] include talc [3–6], antibiotics and antineoplastics [7–9] and autolo- gous blood [10, 11]. The surgical procedures include tho- racoplasty, myoplasty, open pleural drainage, control by suturing or occlusion with biological agent [12]. Autologous blood was originally used to avoid relapse of spontaneous primary pneumothorax [10] and its effi- cacy in treating persistent air leak was later verified [13] . Fibrin formed from the fibrinogen contained in blood does not provide firm fixing for the pleura, and is not in- dicated for treatment in pleural effusion, but seems to be adequate for aerial fistula occlusion. The objective of this study is to show the results of treating persistent pleuropulmonary air leak with autolo- gous blood and review literature on this specific method of treatment. Key Words Blood  Fistula  Pleura  Pneumothorax Abstract Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage. Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treat- ment. Methods: Retrospective study of patients with persis- tent aerial pleuropulmonary fistula treated with autologous blood. The patient’s own blood was collected from a periph- eral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon imped- ed blood return but not air escape. Results: Between Janu- ary 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure. Conclusion: Treating persistent pleuropulmo- nary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness. Copyright © 2009 S. Karger AG, Basel Received: February 17, 2009 Accepted after revision: April 13, 2009 Published online: June 24, 2009 Antonio José Maria Cataneo Thoracic Surgery Discipline of the Surgery and Orthopedics Department Botucatu School of Medicine, São Paulo State University, UNESP 18618-970 Botucatu, SP (Brazil) Tel. +55 14 3815 6230, Fax +55 14 3815 7615, E-Mail acataneo @ fmb.unesp.br © 2009 S. Karger AG, Basel 0025–7931/10/0794–0302$26.00/0 Accessible online at: www.karger.com/res