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Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China.
- Source :
-
Respiration; international review of thoracic diseases [Respiration] 2019; Vol. 97 (5), pp. 436-443. Date of Electronic Publication: 2019 Mar 22. - Publication Year :
- 2019
-
Abstract
- Background: Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial.<br />Objective: To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs.<br />Methods: This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications.<br />Results: In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects.<br />Conclusion: ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.<br /> (© 2019 S. Karger AG, Basel.)
- Subjects :
- Aged
Bioprosthesis
Chest Tubes adverse effects
Drainage methods
Female
Humans
Male
Middle Aged
Pleural Diseases complications
Treatment Outcome
Bronchoscopy methods
Pneumothorax diagnosis
Pneumothorax etiology
Pneumothorax physiopathology
Pneumothorax therapy
Postoperative Complications diagnosis
Postoperative Complications therapy
Respiratory Tract Fistula etiology
Respiratory Tract Fistula therapy
Thoracentesis adverse effects
Thoracentesis instrumentation
Thoracentesis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1423-0356
- Volume :
- 97
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Respiration; international review of thoracic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 30904909
- Full Text :
- https://doi.org/10.1159/000495298