Pleurodesis using autologous blood:: a new concept in the management of persistent air leak in acute respiratory distress syndrome

Objective: Pneumothorax is present as a frequent complication in acute respiratory distress syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary surgery. The goal of this study was to compare PAB with the conventional drain and water seal in the management of PAL in patients with ARDS and pneumothorax. Design: The study was a case-control, prospective, nonrandomized one comparing 2 groups subjected to artificial pairing (1:1). Setting: The study took place at the Torrecardenas Hospital (Andalusian Health Service, Almeria, Spain). Patients: Participants were 2 groups of 27 patients, all with ARDS, pneumothorax, and PAL. Interventions: One group received conventional treatment whereas the other received PAB. Main results: The severity of the conditions of both groups is homogeneous, shown by sex; age; Murray, Marshall, and Acute Physiology and Chronic Health Evaluation II scores; and etiology of ARDS. The patients in the PAB group had a shorter stay in the ICU, shorter weaning time (WT), and lower death rate. The average differences between the groups were 11 days less WT (adjusted odds ratio [OR] = 0.1) and 9 days less on average time spent in the ICU (adjusted OR = 0.24). The death rates in the PAB group and the control group were 3.7% and 29.6%, respectively (adjusted OR = 0.6). Conclusions: The use of PAB makes possible a decrease in ventilator WT and a shorter stay in the ICU, with a resulting increase in functional recuperation and decrease in patient mortality. (C) 2006 Elsevier Inc. All rights reserved.