ABSTRACT
Fourteen adults with spontaneous pneumothorax (SP), 9 of whom had primary SP (PSP) and 5 of whom had secondary forms (SSP), were given intrapleural infusions of self-donated blood for pleurodesis. Instillations of 50 ml were given to all except 1, who required a total volume of 120 ml. The procedure was performed in each patient's bed in all cases. With apical chest tube placement in most cases and the lung expanded, the outer tip of the tube was elevated and the patient's own blood was taken from a superficial forearm vein and instilled. Them, with the tube occluded, the patient's were rotated un bed for a period of 2 hours to distribute the blood evenly throughout the pleural cavity. Tolerance was excellent, with no pain reported by any patient. The only noteworthy complication was 1 case of infectious pleural effusion of unknown etiology which was treated by evacuation and antibiotics. In 13 (92%) patients closure of the fistula was achieved, in under 12 h in 7 (53%), in under 24 h in 3 (23%), in under 48 h in 2 (15%), and in under 72 h in the remaining 2 (15%). In 4 (28.5%) there was recurrence (2 SSP and 2 PSP patients). Over a 10 to 32 month follow-up period (mean 16 months), 10 (71.4%) patients experienced no recurrences or complications. These results allow us to speculate that blood instilled in the pleural cavity may act in 2 ways: in the short term as a blood patch that adheres to and closes the fistula in the visceral pleura, and over the longer term by creating pleural symphysis by adhesions and fibrous tissue. Our limited experience indicates that pleurodesis with self-donated blood is an easy-to-perform, painless, convenient, rapid and inexpensive procedure that is moderately effective in the short and medium term. Its main drawbacks are the lack of consensus on certain technical considerations, such as the optimum amount of blood to be instilled, the number of instillations to perform and, if multiple instillations are carried out, what the interval between them should be. Further study is needed to confirm or discount our results and to determine the place this technique may have in the clinical management of pneumothorax.
