AUTOLOGOUS BLOOD PATCH PLEURODESIS IN PAEDIATRIC PERSISTENT AIR LEAK ASSOCIATED WITH COMPLICATED PNEUMONIA

Abstract

Introduction/Aim: Incidence of complicated pneumonia in children has seen a rise worldwide over the last decade1. Persistent air leak (PAL) is an uncommon sequalae of complicated pneumonia but can result in increased length of hospital stay, morbidity and cost to healthcare facilities and families. The use of autologous blood patch (ABP) pleurodesis for PAL has been shown to be a safe, effective and non-invasive treatment in the adult population. However, there is limited studies within the paediatric population. During a nationwide Heimlich valve shortage, ABP pleurodesis was used in 3 cases of PAL following empyema. Methods: Three children requiring ABP pleurodesis for PAL secondary to complicated pneumonia were identified from the previous two years at Queensland Children's Hospital. A review of electronic records was performed to identify demographic data, aetiology of air leak, type of surgical intervention, duration of air leak, and time to resolution. Results: Three vaccinated children (age 2, 4 and 7 years) with necrotising pneumonia and empyema secondary to S. pneumoniae (serotype 3 in two patients, unknown serotype in the other) were identified. Two children had a primary video-assisted thoracoscopic surgery (VATS), and one had intercostal catheter (ICC) insertion with fibrinolytics, and proceeded to VATS on D18 for non-resolution of symptoms. ABP pleurodesis was performed after PAL of 19-26 days duration and resulted in successful resolution 2-5 days post-ABP pleurodesis. One child had haemoptysis at time of procedure which self-resolved. Conclusion: This small case series describes successful use of ABP pleurodesis for PAL in children with complicated pneumonia. Given the relative procedural ease and minimal complications, this should be the preferred treatment strategy and should be instituted early to reduce hospital stay associated cost and morbidity.