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Otolog Kan Yaması Plörodezisi: Çocuklarda Uzun Süreli Hava Kaçağı İçin Güvenilir Bir Tedavi Seçeneği

Yıl 2022, Cilt: 16 Sayı: 2, 150 - 153, 16.03.2022
https://doi.org/10.12956/tchd.1075688

Öz

Amaç: Israrcı hava kaçakları, göğüs tüpü çekilmesini geciktiren ve uzun süreli hastanede yatışa neden olan sık komplikasyonlardan biridir. Literatürde uzun süreli hava kaçakları (UHK) için otolog kan yaması plörodezisi (OKYP) yapılması hakkında sınırlı ancak olumlu deneyimler mevcuttur. Çocuklarda etkinliği ve güvenilirliği konusunda OKYP’nin UHK için uygulanması konusunda deneyimlerimizi paylaşmayı amaçladık.

Gereç ve Yöntemler: UHK’li 18 yaş altı hastalarda geriye dönük tek merkezli bir çalışma yapılmıştır. UHK, 5 günden uzun süren alveolar-plevral fistüllerin varlığı olarak tanımlandı. Geçirilmiş göğüs cerrahisi, göğüs travması ve UHK ‘nin spontan pnömotoraksı gibi etiyolojik nedenleri dahil edildi. Çalışmaya 1 Ocak 2016’dan 1 Aralık 2021’e kadar olan hastalar dahil edildi. Otolog kan yaması plöredezi (OKYP) önceden var olan bir göğüs tüpü aracılığıyla gerçekleştirildi. 1. günde periferik venden alınan 1-2 cc/kg taze tam kan mevcut göğüs tüpünden verildi. Hava kaçağının devam etme durumunda işlem 2. ve 4. günlerde tekrarlandı. Kaçak devam etse de maksimum üç uygulama hedeflendi. Takip süresi boyunca işlem ilişkili komplikasyonlar değerlendirildi. Tam başarı, hava kaçaklarının giderilmesi olarak kabul edildi.

Bulgular: Erkek çocukların daha sık olduğu toplam 11 hasta değerlendirildi (n=7, %63.9). UHK için OKYP uygulanan çocukların yaş ortalaması 13.4±2.1 yıldı (IQR 10-17). Ortalama tekrarlanan prosedür sayısı, 1 ila 3 uygulama arasında değişmekle beraber 1.8 saptandı. Çalışma grubumuzda en sık etiyolojik nedeni spontan pnömotoraksa ikincil yapılan torasik girişimlerdi. Altı olguda ilk uygulamadan sonra (%54.5) tam iyileşme mümkün oldu ve tüm olgularda OKYP prosedürleri tekrarlandıktan sonra UHK düzeldi (%100 iyileşme). OKYP’e bağlı herhangi bir komplikasyon saptanmadı.

Sonuç: Çocuklarda PAL için alternatif tedavi seçeneği olan otolog kan yaması plörodezis (ABPP) ile ilgili deneyimlerimizi paylaşmak istiyoruz. ABPP, etkinliği yüksek, komplikasyonlardan uzak, kolay uygulanabilir bir tedavi olup, serimizin tüm hastalarında PAL için ABPP kullanımı başarılı olmuştur.

Kaynakça

  • 1. Sakata KK, Reisenauer J, Kern RM and Mullon JJ. Persistent air leak-review. Respir Med 2018;137:213-8.
  • 2. Rinaldi S, T Felton, and A Bentley. Blood pleurodesis for the medical management of pneumothorax. Thorax 2009;64:258-60.
  • 3. Henry M, Arnold T and Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58: ii39-52.
  • 4. Cerfolio RJ and Bryant AS. The management of chest tubes after pulmonary resection. Thorac Surg Clin 2010;20:399-405.
  • 5. 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;82:1052-6.
  • 6. Hallifax R, Yousuf A, Jones HE, Corcoran JP, Psallidas I and Rahman NM. Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review. Thorax 2017;72:1121-31.
  • 7. Györik S, Erni S, Studler U, Wuerz RH, Tamm M and Chhajed PN. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007;29:757-60.
  • 8. Light RW, Hara VSO, Moritz TE, McElhinney Aj, Butz R, Haakenson CM et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study. JAMA 1990;264:2224-30.
  • 9. Lillegard JB, Kennedy RD, Ishitani MB, Zarroug AE, Feltis B. Autologous blood patch for persistent air leak in children. J Pediatr Surg 2013;48:1862-6.
  • 10. Dugan KC, Laxmanan B, Murgu S and Hogarth DK. Management of persistent air leaks. Chest 2017;152: 417-23.
  • 11. Dumire R, Crabbe MM, Mappin FG and Fontenelle LJ. Autologous “blood patch” pleurodesis for persistent pulmonary air leak. Chest 1992;101:64-6.
  • 12. Lang-Lazdunski L and 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.
  • 13. Pruitt LC, Kastenberg ZJ, Fenton SJ and Short S. Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks. J Pediatr Surg 2021;56:629-31.
  • 14. Mingorance AN, Pastor Vİvero MD, Leon MC, Dominguez SBR and Soler JL. Autologous ‘‘blood patch’’pleurodesis: A safe and useful treatment for persistent pneumothorax in children. An Pediatr (Barc) 2016;85:157-8.
  • 15. de Andrés JJR, Blanco S and de la Torre M. Postsurgical pleurodesis with autologous blood in patients with persistent air leak. Ann Thorac Surg 2000;70:270-2.
  • 16. Campisi A, Dell Amore A, Gabryel P, Ciarrocchi AP, Sielewicz M, Zhang Y, et al. Autologous Blood Patch Pleurodesis: A Large Retrospective Multicenter Cohort Study. Ann Thorac Surg 2021; S0003-4975(21)01386-2.
  • 17. Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428-9.
  • 18. Ibrahim IM, Abd Elaziz ME and El-Hag-Aly MA. Early autologous blood-patch pleurodesis versus conservative management for treatment of secondary spontaneous pneumothorax. Thorac Cardiovasc Surg 2019;67: 222-6.

Autologous Blood Patch Pleurodesis: A Reliable Treatment Option For Prolonged Air Leakage in Children

Yıl 2022, Cilt: 16 Sayı: 2, 150 - 153, 16.03.2022
https://doi.org/10.12956/tchd.1075688

Öz

Objective: Persistent air leaks remain one of the most complications that delay chest tube removal and prolonged
hospitalization. In literature, there are limited but favorable results about autologous blood patch pleurodesis (ABPP)
for prolonged air leaks (PAL). We aimed to describe our experiences with ABPP for PAL regarding its effectiveness and
reliability in children.

Material and Methods: A retrospective single-center study was performed on patients under 18 years of age with
PAL. PAL was defined as the presence of alveolar-pleural fistulas lasting longer than 5 days. The etiological causes
including previous thoracic surgery, thoracic trauma, and spontaneous pneumothorax of PAL were included. The study
took into account patients from January 1, 2016, to December 1, 2021. Autologous blood patch pleurodesis (ABPP)
was performed through a pre-existing chest tube. 1-2 cc/kg of fresh whole blood that was taken from a peripheral
vein and instilled through the existing chest tube on day 1. The procedure was repeated on days 2 and 4 if the air leak
persisted with a maximum limit of three. During the follow-up period, complications of the procedure were evaluated.
Complete success was considered as resolving air leaks.

Results: Of 11 children, males were more common (n=7, 63.9%). The mean age of children who underwent ABPP
for PAL was 13.4 2.1 years (IQR 10-17). The mean number of repeating procedures was 1.8 ranging from 1 to 3
applications. In our study group, thoracic procedures secondary to spontaneous pneumothorax were the most common
etiologic cause. Most of the patients had PAL during forced expiration only (n=6, 54.5%), and the mean number of
ABPP applications was found 1.7 in this group. But the patients having continuous PAL required 3.1 applications
for improvement (mean value). Complete recovery was possible in six cases after the first application (54.5%). PAL
improved in all cases after repeating ABPP procedures (100% healing). We had seen no complications in terms of
respiratory distress due to the application of ABPP or infection.

Conclusion: We report about our experiences of autologous blood patch pleurodesis (ABPP) in children as an alternative
treatment option for PAL. ABPP is an easily applicable therapy with high effectiveness and being away from complications
and, the use of ABPP for PAL was successful in all patients of our series.

Kaynakça

  • 1. Sakata KK, Reisenauer J, Kern RM and Mullon JJ. Persistent air leak-review. Respir Med 2018;137:213-8.
  • 2. Rinaldi S, T Felton, and A Bentley. Blood pleurodesis for the medical management of pneumothorax. Thorax 2009;64:258-60.
  • 3. Henry M, Arnold T and Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58: ii39-52.
  • 4. Cerfolio RJ and Bryant AS. The management of chest tubes after pulmonary resection. Thorac Surg Clin 2010;20:399-405.
  • 5. 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;82:1052-6.
  • 6. Hallifax R, Yousuf A, Jones HE, Corcoran JP, Psallidas I and Rahman NM. Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review. Thorax 2017;72:1121-31.
  • 7. Györik S, Erni S, Studler U, Wuerz RH, Tamm M and Chhajed PN. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Respir J 2007;29:757-60.
  • 8. Light RW, Hara VSO, Moritz TE, McElhinney Aj, Butz R, Haakenson CM et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study. JAMA 1990;264:2224-30.
  • 9. Lillegard JB, Kennedy RD, Ishitani MB, Zarroug AE, Feltis B. Autologous blood patch for persistent air leak in children. J Pediatr Surg 2013;48:1862-6.
  • 10. Dugan KC, Laxmanan B, Murgu S and Hogarth DK. Management of persistent air leaks. Chest 2017;152: 417-23.
  • 11. Dumire R, Crabbe MM, Mappin FG and Fontenelle LJ. Autologous “blood patch” pleurodesis for persistent pulmonary air leak. Chest 1992;101:64-6.
  • 12. Lang-Lazdunski L and 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.
  • 13. Pruitt LC, Kastenberg ZJ, Fenton SJ and Short S. Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks. J Pediatr Surg 2021;56:629-31.
  • 14. Mingorance AN, Pastor Vİvero MD, Leon MC, Dominguez SBR and Soler JL. Autologous ‘‘blood patch’’pleurodesis: A safe and useful treatment for persistent pneumothorax in children. An Pediatr (Barc) 2016;85:157-8.
  • 15. de Andrés JJR, Blanco S and de la Torre M. Postsurgical pleurodesis with autologous blood in patients with persistent air leak. Ann Thorac Surg 2000;70:270-2.
  • 16. Campisi A, Dell Amore A, Gabryel P, Ciarrocchi AP, Sielewicz M, Zhang Y, et al. Autologous Blood Patch Pleurodesis: A Large Retrospective Multicenter Cohort Study. Ann Thorac Surg 2021; S0003-4975(21)01386-2.
  • 17. Robinson CL. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax. Can J Surg 1987;30:428-9.
  • 18. Ibrahim IM, Abd Elaziz ME and El-Hag-Aly MA. Early autologous blood-patch pleurodesis versus conservative management for treatment of secondary spontaneous pneumothorax. Thorac Cardiovasc Surg 2019;67: 222-6.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm ORIGINAL ARTICLES
Yazarlar

Müjdem Nur Azılı 0000-0002-5137-7209

Doğuş Güney 0000-0001-7168-2123

Gökhan Demirtaş 0000-0003-0787-2330

Süleyman Arif Bostancı 0000-0002-7512-3895

Elif Erten 0000-0002-3666-295X

Ahmet Ertürk 0000-0002-8156-5665

Can Öztorun 0000-0002-5408-2772

Sabri Demir 0000-0003-4720-912X

Emrah Şenel 0000-0002-0383-4559

Yayımlanma Tarihi 16 Mart 2022
Gönderilme Tarihi 18 Şubat 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 16 Sayı: 2

Kaynak Göster

Vancouver Azılı MN, Güney D, Demirtaş G, Bostancı SA, Erten E, Ertürk A, Öztorun C, Demir S, Şenel E. Autologous Blood Patch Pleurodesis: A Reliable Treatment Option For Prolonged Air Leakage in Children. Türkiye Çocuk Hast Derg. 2022;16(2):150-3.

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