Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy.

OBJECTIVE

The purpose of this study was to determine whether an autologous intraparenchymal blood patch reduces the rate of pneumothorax and the rate of pneumothorax requiring chest tube placement after percutaneous lung biopsy.

SUBJECTS AND METHODS

A prospective randomized controlled trial enrolling 242 patients was conducted. Adult patients undergoing percutaneous biopsy of lung or mediastinal lesions of undetermined cause were candidates. Patients were excluded if aerated lung tissue was not crossed during the biopsy. A standard biopsy procedure was followed for all patients until an adequate tissue sample was obtained. Patients were then randomized. For patients randomized to the treatment group, an intraparenchymal blood patch was administered through the guiding needle on removal. The same postbiopsy procedures were followed for both the treatment and control groups. Data collected included development of pneumothorax and placement of a chest tube.

RESULTS

The rate of pneumothorax was reduced from 35% to 26% (p = 0.12) with the use of the blood patch, but the reduction was not significant. The rate of pneumothorax requiring chest tube placement was significantly reduced from 18% to 9% (p = 0.048). There was a greater benefit in the blood patch group when a 19-gauge guiding needle was used: Pneumothorax requiring chest tube placement was reduced from 19% to 3% whereas an increase from 16% to 20% was seen with a 17-gauge needle (p = 0.029).

CONCLUSION

The use of an autologous intraparenchymal blood patch significantly reduces the rate of pneumothorax requiring chest tube placement. It seems to be more beneficial when a 19-gauge guiding needle is used.