ª 2022 by The Society of Thoracic Surgeons 0003-4975/$36.

00 273
Published by Elsevier Inc. https://doi.org/10.1016/j.athoracsur.2021.06.089

Autologous Blood Patch Pleurodesis: A

Large Retrospective Multicenter Cohort
Study
Alessio Campisi, MD, Andrea Dell’Amore, MD, PhD, Piotr Gabryel, MD, PhD,
Angelo Paolo Ciarrocchi, MD, Magdalena Sielewicz, MD, Yonghui Zhang, MD,
Zhitao Gu, MD, PhD, Eleonora Faccioli, MD, Franco Stella, MD, PhD, Federico Rea, MD, PhD,
Wentao Fang, MD, PhD, and Cezary Piwkowski, MD, PhD

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; Thoracic

GENERAL THORACIC
Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì,
Italy; Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University
Hospital, University of Padua, Padua, Italy; and Department of Thoracic Surgery, Poznan University of Medical
Sciences, Poznan, Poland

ABSTRACT

BACKGROUND Prolonged air leaks (PAL) complicate 10% to 15% of lung resections, delaying chest tube removal and
prolonging length of hospital stay. No consensus exists for managing this common complication, despite favorable
results for autologous blood patch pleurodesis (ABPP) in the literature. The aim of this study was to evaluate the
effectiveness and safety of ABPP.

METHODS We retrospectively reviewed medical records of 510 patients with PAL after lobectomy in four centers
between January 2010 and December 2019. They were divided into two groups: group A consisted of patients who
received ABPP for PAL of more than 5 days; and group B was patients for whom no ABPP or other procedure was
performed for PAL unless strictly necessary. Propensity score matched analysis was performed, and 109 patients were
included in each group. Time to cessation of air leak and chest tube removal, length of hospital stay, reoperation, and
complications rate were examined.

RESULTS After the propensity score matching, ABPP significantly reduced the number of days before chest tube
removal (8.12 vs 9.30, P [ .004), and length of hospital stay (10 vs 11 days, P [ .045) with fewer perioperative com-
plications (6 vs 17, P [ .015). Furthermore, ABPP was related to lower incidence of any additional invasive procedures (0
vs 9, P [ .002) and reoperation (0 vs 4, P [ .044). No patient in the ABPP group had long-term complications related to
pleurodesis.

CONCLUSIONS Autologous blood patch pleurodesis is safe and effective in reducing length of hospital stay and leads
to earlier chest tube removal without increasing complications.
(Ann Thorac Surg 2022;114:273-9)
ª 2022 by The Society of Thoracic Surgeons

P ersistent air leak (PAL) is the second most com-

mon complication after arrhythmia during the
postoperative period of lung surgery, with an
incidence ranging from 9.7% to 15.2%. 1,2
Despite its fre-
the other is based on the habits of individual surgeons
and departments rather than on an evidence-based
consensus of opinion.4 One of the procedures used is
autologous blood patch pleurodesis (ABPP). The patho-
quency, there is no gold standard approach to managing physiologic mechanism of ABPP is believed to be the
PAL. Observation, continuous or intermittent suction,
slurry pleurodesis with different agents, pneumoperito-
The Supplemental Table can be viewed in the online version of this
neum, endobronchial sealing, or surgery have all been
3
article [10.1016/j.athoracsur.2021.06.089] on http://www.
used to treat PAL. Every approach has its advantages annalsthoracicsurgery.org.
and disadvantages, and the use of one method over

Accepted for publication Jun 25, 2021.

Address correspondence to Dr Campisi, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Rd,
Shanghai 200030, China; email: alessio.campisi@studio.unibo.it.
 274 CAMPISI ET AL
BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS
sclerosing nature of blood (not as effective as other
agents) induced by a noninfectious inflammatory reac-
tion of the pleura, as well as the formation of fibrin,
which occludes alveolar air leaks, leading to lung reex-
pansion and further sealing of air leaks.5
Although controversial, ABPP is performed world-
wide thanks to its simplicity, inexpensiveness, and
perceived safety. Dumire and associates6 successfully
used the technique to treat a patient with a 5-week-long
PAL after a lobectomy that was resolved after a single
GENERAL THORACIC
ABPP attempt.6 A study performed by Andreetti and
colleagues7 demonstrated the effectiveness of blood
patch; however, the study population was limited.
Shackcloth and associates,8 in another randomized trial,
demonstrated a significantly shortened chest tube
duration and length of stay (LOS); however, only 20
patients were enrolled. Lang-Lazdunski and Coonar9
performed blood patch pleurodesis in 11 patients using
50 mL blood, and all air leaks were resolved within 48
hours. Oliveira and colleagues10 retrospectively enrolled
27 patients in their study in which blood patch pleu-
rodesis was successful in 85% of patients. Recently,
however, Ploenes and colleagues11 published a pro-
spective randomized study involving 24 patients in
which they concluded that pleurodesis offered no
benefit and that early surgical intervention was more
effective as a means of treating PAL.
Autologous blood patch pleurodesis could help
manage PAL after pulmonary resection; therefore, in this
study we aim to evaluate the efficacy of ABPP by
comparing the outcomes of a group of patients who
underwent ABPP and a control group who underwent
observation alone or an invasive procedure (chest tube
reinsertion or surgery) to treat PAL.
MATERIAL AND METHODS
This study is a multicenter cohort retrospective study of
consecutive patients who had PAL after pulmonary lo-
bectomy for neoplastic disease between January 2010
and December 2019. Two groups were created: ABPP was
used for PAL in group A; and observation (followed by
chest tube insertion or reoperation, if needed, to treat
PAL in some cases) was used in group B.
The primary endpoints of this retrospective study
were chest drainage duration, LOS, and early complica-
tions. The secondary endpoints were reintervention rate
(defined as chest tube insertion or reoperation); overall
response rate to ABPP (defined as the total number of
patients with interruption of air leak minus the patients
who had reintervention for air leak, divided by the total
number of patients); and assessment of predictive vari-
ables of ABPP success.
All patients who underwent VATS or open lobec-
tomies were included in the study. A bronchoscopy was
Ann Thorac Surg
2022;114:273-9
performed in each patient to exclude a bronchopleural
fistula to avoid further complications related to blood
pleurodesis. In each case, we ensured the correct posi-
tioning of the chest drains and air tightness of the sys-
tem. The exclusion criteria were nonanatomic lung
resections; segmentectomies; lobectomies associated
with chest wall or diaphragm resections; lobectomies
needing prolonged postoperative ventilator assistance;
sleeve lobectomies; hemothorax as a postoperative
complication; reintervention in the first 5 postoperative
days for complications different from air leaks; and a
bronchopleural fistula documented at the bronchoscopy.
Patient demographics, tumor characteristics, surgical
and oncologic therapy, postoperative complications,
morbidity, mortality, and ABPP-related data were
analyzed.
In group A, the procedure was carried out in the
surgical ward at the patient’s bedside under aseptic
conditions (surgical scrubs, mask, and sterile gloves). No
medication was used to prepare the patient. For each
procedure 60 mL or 120 mL peripheral venous blood was
taken from a peripheral or central venous line and
injected into the pleural cavity by connecting the cone of
a 60-mL syringe to the chest tube (prepared with
povidone-iodine). After application, passive drainage
was used and the drainage system was raised 60 to 80
cm above the level of the patient for 3 hours. During this
time, the patient was asked to change position every 20
minutes (lateral to supine to contralateral) to promote
homogeneous distribution of blood into the pleural
cavity. The tube was monitored regularly for any
obstruction to the air flow. If inefficient, the procedure
was repeated after 24 hours. After cessation of air leak in
the drainage system, the chest tube was clamped for 12
hours; a chest radiograph was obtained before and after
drain removal.
In group B, no specific treatment was performed for
PAL, the chest tube was left in place until the air leak
ceased spontaneously, or until a second surgery was
deemed necessary owing to the persistence of the air
leak. After cessation of air leak in the drainage system,
the chest tube was clamped for 12 hours; a chest radio-
graph was obtained before and after drain removal.
STATISTICAL ANALYSIS. Analyses were conducted with
IBM SPSS Statistics for Windows 25.0 (IBM Corp,
Armonk, NY). Continuous variables are expressed as a
mean
SD or median and range when appropriate, and
categoric variables are expressed as numbers and
percentages.
To minimize the bias caused by nonrandomized pa-
tients, a propensity score matched analysis was used to
eliminate the confounding factors. The propensity score
of each patient was derived from a multivariable logistic
model with covariates, including sex, age, body mass
Ann Thorac Surg CAMPISI ET AL 275
2022;114:273-9 BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS

index, smoking habits, chronic obstructive pulmonary TABLE 1 General Characteristics of Patients After
disease, Global Initiative for Obstructive Lung Disease Propensity Score Matching Analysis
score, number of comorbidities, diabetes mellitus, sur-
Group A Group B
gical approach, type of lobectomy, and previous homo- Characteristics (n ¼ 109) (n ¼ 109) P Value
lateral surgery. A ratio of 1:1 and a caliper size of 0.04 Age 67 (61-71) 67.0 (61-73) .415
were applied for propensity score matching with Sex .677
nearest-neighbor matching algorithm without Male 65 (59.6) 68 (62.4)
replacement. Female 44 (40.4) 41 (37.6)

The significance level was set to 5% (P ¼ .05). The two Smoking 62 (56.9) 67 (61.5) .491
COPD 52 (47.7) 60 (55) .278
groups were compared by unpaired Student’s t test or

GENERAL THORACIC
GOLD 1 17 (15.6) 18 (16.5)
Mann-Whitney U test applied to discrete or continuous
GOLD 2 34 (31.2) 39 (35.8) .792
data, and by the c test applied to dichotomous or
2
GOLD 3 2 (1.8) 3 (2.8)
categoric data. Repeated measures with the analysis of GOLD 4 0 (0) 0 (0)
variance model were performed to test differences be- Comorbidities 1.23 ± 1.006 1.28 ± 0.934 .676
tween the means of the groups. A multivariate Cox Diabetes 10 (9.2) 11 (10.1) .818
mellitus
proportional hazards model was constructed based on
Charlson 5 (4-5) 5 (4-6) .279
hypothesized clinical relevance and results of univariate comorbidity
analysis (P < .2). index
Surgical .358
approach
RESULTS VATS 77 (70.6) 83 (76.1)
Open 32 (29.4) 26 (23.9)
Between January 2010 and December 2019, 8578 pa- Previous 0 (0) 0 (0) ...
ipsilateral
tients met the inclusion criteria of the study with a total
surgery
of 510 patients (5.94%) having a PAL after a lobectomy in Lobectomy .419
our four centers. Group A included 122 patients, and Right upper 41 (37.6) 43 (39.4)
group B included 388. The baseline characteristics of the lobe
Middle lobe 2 (1.8) 4 (3.7)
prematched patients are shown in Supplemental Table 1.
Right lower 24 (22) 14 (12.8)
Before propensity score matching, the groups differed in lobe
terms of smoking, Global Initiative for Obstructive Lung Left upper 33 (30.3) 36 (33)
Disease score, diabetes mellitus, Charlson comorbidity lobe
Left lower 9 (8.3) 12 (11)
index, and surgical approach. After propensity score
lobe
matching, a total of 218 patients (109 for each group)
were included in the final study. Patients’ general Values are median (interquartile range), n (%), or mean ± SD. COPD, chronic
obstructive pulmonary disease; GOLD, Global Initiative for Obstructive Lung
characteristics after propensity score matching are Disease; VATS, video-assisted thoracic surgery.
shown in Table 1. After 1:1 propensity score matching,
the baseline clinicopathologic characteristics did not
differ between these two groups.
In all patients in group A, the first ABPP was admin- required surgery for PAL in group A, whereas 4 patients
istered on the fifth postoperative day. Fifty patients (3.7%) had surgery in group B (in 3 patients a wedge
(45.9%) received 60 mL blood with each ABPP per- resection of the lung in the fissure was performed; in 1
formed, and 59 patients (54.1%) received 120 mL. The patient three stitches and TachoSil [Nycomed GmbH,
median number of ABPPs was 2 (range, 1 to 3.5); the Linz, Austria] were applied; P ¼ .044). No patient was
mean total amount of blood injected in each patient was discharged with a chest tube in place in each group
187.16
96.51 mL; mean time to air leak cessation after (Table 2).
the first ABPP performed was 33.35
29.058 hours; and In group A, we observed six complications (low-grade
after the last one, it was 5.39
3.223 hours. The overall fever treated successfully with empirical antibiotics and
response rate, defined as the air leak cessation, was paracetamol); in group B, we observed 17 complications
100%. In 52 patients (47.7%), the PAL stopped after the (15 were pleural space, defined as a 3-cm gap between
first ABPP; in 14 (12.8%), it stopped after the second one; visceral pleura and chest wall3 and 2 were atelectasis
and in 16 (14.7%), after the third one. Twenty-seven needing endobronchial aspiration; P ¼ .015). Clavien-
patients (24.8%) received more than three ABPPs. Dindo classification was grade II for all patients of
Mean chest drainage duration was shorter in group A group A; it was grade I for 10 patients and grade IIIa for 6
compared with group B (8.12
1.698 vs 9.30
3.889 patients of group B (P < .001).12
days, P ¼ .004; Figure 1). Length of stay was shorter in We performed univariate analyses including all of the
group A (10 vs 11 days, P ¼ .045; Figure 2). No patients risk factors. Two models were assessed. Chest tube
 276 CAMPISI ET AL Ann Thorac Surg
BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS 2022;114:273-9
GENERAL THORACIC

FIGURE 1 Kaplan-Meier curves of chest tube duration in days. Three groups were considered according to amount of
blood injected: 0 mL (purple line), 60 mL (green line), or 120 mL (yellow line). Log rank P less than .001. (ABPP, autologous
blood patch pleurodesis.)

FIGURE 2 Kaplan-Meier curves of length of hospital stay in days. Three groups were considered according to amount of
blood injected: 0 mL (purple line), 60 mL (green line), or 120 mL (yellow line). Log rank P less than .001. (ABPP, autologous
blood patch pleurodesis.)
Ann Thorac Surg CAMPISI ET AL 277
2022;114:273-9 BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS

TABLE 2 Perioperative Characteristics of Patients TABLE 3 Univariate and Multivariate Analyses With
Chest Tube Removal in Days as Dependent Variable
Group A Group B
Characteristics (n ¼ 109) (n ¼ 109) P Value Univariate
Number of 2.0 (1-3.5) ... ... Analysis Multivariate Analysis
ABPPs Variable P Value HR 95% CI P Value
1 52 (47.7)
Age .445 ... ... ...
2 14 (12.8)
Body mass .511 ... ... ...
3 16 (14.7) index
>3 27 (24.8) Smoking .518 ... ... ...
Invasive 0 (0) 9 (8.3) .002 GOLD score .439 ... ... ...

GENERAL THORACIC
procedurea
Number of .928 ... ... ...
Reoperation 0 (0) 4 (3.7) .044 comorbidities
Overall 106 (100) ... ... Diabetes .365 ... ... ...
response rate mellitus
Chest tube 8.12 ± 1.698 9.30 ± 3.889 .004 Charlson .765 ... ... ...
removal after comorbidity
surgery, d index score
Overall hospital 10 (8-13) 11 (9-14) .045 Surgical .347 ... ... ...
length of stay, approach,
d VATS/open
Perioperative 6 (5.5) 17 (15.6) .015 Type of .270 ... ... ...
complications lobectomy,
Clavien-Dindo <.001 upper/lower
classification Amount of .026 0.052 0.016-0.176 <.001
Grade 1 0 (0) 15 (13.8) blood used,
0/60/120 mL
Grade 2 6 (5.5) 0 (0)
Grade 3A 0 (0) 2 (1.8)
CI, confidence interval; GOLD, Global Initiative for Obstructive Lung Disease; HR,
Long-term 0 (0) 0 (0) ... hazard ratio; VATS, video-assisted thoracic surgery.
complications
Thirty-day 0 (0) 1 (0.9) .316
mortality
Ninety-day 0 (0) 0 (0) ... been officially accepted as a treatment protocol. We
mortality
retrospectively analyzed 510 patients with PAL after
a
Values are median (interquartile range), n (%), or mean ± SD. Surgery or chest anatomic lung resection, and after propensity score
tube insertion, or both. ABPP, autologous blood patch pleurodesis. matching analysis, our study included 218 patients, 109
who received ABPP and 109 who underwent observa-
tion. A propensity-score matching approach was used to
removal in days was set as the dependent variable in the account for potential confounding factors related to the
first model (Table 3). The dependent variable in the nonrandom allocation of the patients to the intervention
second model was the LOS in days (Table 4). In both groups.
models, the amount of blood used for each ABPP (0/60/ This population is particularly large for an ABPP
120 mL) had a P value less than .1, and it was found to be study, as previous studies did not manage to enroll more
an independent predictive factors for successful than 30 patients at a time. The overall median LOS in
drainage removal and shorter LOS in multivariate ana- days and the days to chest tube removal were lower in
lyses; therefore, the more blood used in ABPP, the group A (P ¼ .045 and P ¼ .004, respectively). No pa-
higher the possibility of having the chest tube removed tients in the blood patch group had to undergo a second
and being discharged from the hospital. surgery to resolve the air leak whereas 9 patients in the
One patient in group B died of myocardial infarction control group underwent an invasive procedure to treat
in the first 30 days (P ¼ .316). Chest radiography or the PAL. The overall response rate to ABPP was 100%. In
computed tomography scan was performed in all pa- nearly 50% of the treated patients, a single blood injec-
tients at 3 to 6 months postoperatively and demon- tion was effective to stop PAL, and in 75% of the pa-
strated reexpanded lungs and no complications in both tients, PAL was resolved after three injections of blood.
groups. Although in the literature the procedure and the time
intervals for administering the blood are fairly stan-
dardized, that is not the case for the quantity of blood to
COMMENT
be injected into the pleural cavity, which varies between
Robsinson and colleagues 13
first described ABPP in 1987 50 mL and 150 mL.6-11 According to our previous expe-
to treat 25 patients with PAL after spontaneous pneu- rience,14 120 mL is the optimal amount of blood to treat
mothorax with a success rate of 85%. The ABPP pro- PAL, and the procedure can be safely repeated every 24
cedure is used worldwide to treat PAL, yet it has never hours. Indeed, higher amounts of blood do not increase
 278 CAMPISI ET AL Ann Thorac Surg
BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS 2022;114:273-9

TABLE 4 Univariate and Multivariate Analyses With

injection of a liquid into the pleural cavity. This compli-
Length of Hospital Stay in Days as Dependent Variable cation is widely described, and more frequently after in-
jection of sclerosing agents or talc.17 Conversely, the
Univariate
Analysis Multivariate Analysis
persistence of an air leak is not only the cause of a pro-

Variables P Value HR 95% CI P Value

longed hospitalization but it is in itself a cause of possible
Age .122 ... ... ...
complications in the postoperative period. This aspect has
Smoking .766 ... ... ... already been described in the literature and is the reason
Chronic obstructive .669 ... ... ... for the attention in preventing and treating PAL.4
pulmonary
Despite many small retrospective studies demon-
disease
GENERAL THORACIC

GOLD score .327 ... ... ...

strating its efficacy, it has not been accepted by the
Number of .348 ... ... ... community at large as an effective treatment owing to
comorbidities the stigma associated with potential complications, such
Diabetes mellitus .192 ... ... ...
as tension pneumothorax due to chest drain obstruc-
Charlson .558 ... ... ...
comorbidity index tion.18 A case report was published involving a 19-year-
score old patient who had a tension pneumothorax after a
Surgical approach, .514 ... ... ... small bore (12F) intercostal catheter was occluded;18
VATS/open
however, that can be avoided by using large bore chest
Type of lobectomy, .940 ... ... ...
upper/lower tubes and by regularly monitoring the chest tube for any
Amount of .000 0.036 0.010-0.126 <.001 obstructions. Other cases of serious complications after
blood used,
0/60/120 mL ABPP have not been reported in the literature. Based on
our results with a population size far greater than pre-
CI, confidence interval; GOLD, Global Initiative for Obstructive Lung Disease; HR, vious studies, and on the low rate of complications that
hazard ratio; VATS, video-assisted thoracic surgery.
the blood patch group had, we believe that ABPP is
effective and should be performed in selected patients
to avoid reoperation and to seal air leaks in a timely
the risk of complications, but help reduce the necessity manner, thereby reducing LOS.
to repeat the procedure and consequently the total The present study has several limitations to be
amount of blood injected to have an air leak stop. acknowledged. Firstly, it is a retrospective study. Sec-
Considering the best time interval to repeat the ABPP, ondly, the study population involves four centers in
our results show that in no patients air leak would stop three different countries with different surgical habits
after 24 hours if the previous ABPP did not work; and different patient morphology that may influence the
therefore, it should be repeated every day. results; moreover, the number of patients from each
Perioperative complications occurred less frequently center is different, with nearly one third of the patients
in the blood patch group as opposed to the control group from Shanghai, one third from Poland, and one third
(P ¼ .015). In this study, we confirm that the rate of from the two remaining centers. Thirdly, the blood patch
complications secondary to the use of the patch is group includes patients with two different amounts of
negligible, in particular the complication reported more blood injected. Randomized control trials with large
frequently is a modest increase in body temperature sample size are needed and welcomed to create a
without, however, consequent evolutions in septic consensus of opinion on the efficacy and role of ABPP in
problems, in particular, empyema.15 It is commonly clinical practice.
thought that the autologous blood may provide a culture In conclusion, ABPP is a simple, inexpensive, effec-
medium for bacteria to proliferate, thereby increasing tive, and prompt method to treat persistent air leak after
the risk of empyema, which is the most commonly re- a lobectomy. In our experience ABPP was successful in
ported complication after blood patch. Despite this, the all cases, it reduced the LOS, chest tube removal was
highest incidence rate of empyema reported in the able to be performed sooner, patients had fewer post-
literature was in a study by Cagirici and colleagues15 in operative complications, and there was no need for pa-
which 3 (9%) of the 32 patients who underwent pleu- tients to undergo a second surgery to treat the air leak
rodesis had empyema. It can be argued that PAL itself is when compared with an observation group.
a risk factor for empyema, and therefore we cannot be
sure if it was the air leak or the autologous blood that The Institutional Review Boards of the four units waived the need for ethical
caused the empyema.16 In our experience, fever (body approval and the need to obtain consent for the collection, analysis, and

temperature greater than 37.5 C) after ABPP can be publication of the retrospectively obtained and anonymized data for this
noninterventional study.
interpreted as a pleural inflammatory reaction to the
Ann Thorac Surg
2022;114:273-9
REFERENCES
1. Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of
prolonged air leak after lobectomy. Ann Thorac Surg. 2010;90:204-209.
2. Manley K, Coonar A, Wells F, Scarci M. Blood patch for persistent air
leak: a review of the current literature. Curr Opin Pulm Med. 2012;18:333-
338.
3. Korasidis S, Andreetti C, D’Andrilli A, et al. Management of residual
pleural space and air leaks after major pulmonary resection. Interact Car-
diovasc Thorac Surg. 2010;10:923-925.
4. Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of persis-
tent air leaks. Chest. 2017;152:417-423.
5. Mueller MR, Marzluf BA. The anticipation and management of air leaks
and residual spaces post lung resection. J Thorac Dis. 2014;6:271-284.
6. Dumire R, Crabbe MM, Mappin FG, Fontenelle LJ. Autologous "blood
patch" pleurodesis for persistent pulmonary air leak. Chest. 1992;101:64-66.
7. Andreetti C, Venuta F, Anile M, et al. Pleurodesis with an autologous
blood patch to prevent persistent air leaks after lobectomy. J Thorac Car-
diovasc Surg. 2007;133:759-762.
8. Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural
instillation of autologous blood in the treatment of prolonged air leak after
lobectomy: a prospective randomized controlled trial. Ann Thorac Surg.
2006;82:1052-1056.
9. Lang-Lazdunski L, Coonar AS. A prospective study of autologous “blood
patch” pleurodesis for persistent air leak after pulmonary resection. Eur J
Cardiothorac Surg. 2004;26:897-900.
CAMPISI ET AL 279
BLOOD PATCH FOR POSTOPERATIVE AIR LEAKS
10. Oliveira FH, Cataneo DC, Ruiz RL, Cataneo AJ. Persistent pleuro-
pulmonary air leak treated with autologous blood: results from a university
hospital and review of literature. Respiration. 2010;79:302-306.
11. Ploenes T, Kyritsis I, Mardanzai K, et al. A prospective study investi-
gating blood patch pleurodesis for postoperative air leaks after pulmonary
resection. J Surg Res. 2020;255:240-246.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical compli-
cations: a new proposal with evaluation in a cohort of 6336 patients and
results of a survey. Ann Surg. 2004;240:205-213.
GENERAL THORACIC
13. Robinson CL. Autologous blood for pleurodesis in recurrent and
chronic spontaneous pneumothorax. Can J Surg. 1987;30:428-429.
14. Campisi A, Dell’Amore A, Zhang Y, et al. Autologous blood pleurodesis:
what is the optimal time interval and amount of blood? Published online
April 13, 2021. Thorac Cardiovasc Surg. https://doi.org/10.1055/s-0041-
1727129
15. Cagirici U, Sahin B, Cakan A, Kayabas H, Buduneli T. Autologous blood
patch pleurodesis in spontaneous pneumothorax with persistent air leak.
Scand Cardiovasc J. 1998;32:75-78.
16. Droghetti A, Schiavini A, Muriana P, et al. Autologous blood patch in
persistent air leaks after pulmonary resection. J Thorac Cardiovasc Surg.
2006;132:556-559.
17. Wan YY, Zhai CC, Lin XS, et al. Safety and complications of medical
thoracoscopy in the management of pleural diseases. BMC Pulm Med.
2019;19:125.
18. Williams P, Laing R. Tension pneumothorax complicating autologous
“blood patch” pleurodesis. Thorax. 2005;60:1066-1067.