TY - JOUR

T1 - ERASURE

T2 - early autologous blood pleurodesis for postoperative air leaks — a randomized, controlled trial comparing prophylactic autologous blood pleurodesis versus standard watch and wait treatment for postoperative air leaks following thoracoscopic anatomic lung resections

AU - Karampinis, Ioannis

AU - Ruckes, Christian

AU - Doerr, Fabian

AU - Bölükbas, Servet

AU - Ricciardi, Sara

AU - Cardillo, Giuseppe

AU - Galvez, Carlos

AU - Vidmar, Bogdan

AU - Stupnik, Tomaz

AU - Fang, Vincent

AU - Petersen, Rene Horsleben

AU - Roessner, Eric Dominic

N1 - Funding Information: Open Access funding enabled and organized by Projekt DEAL. The trial will be funded with institutional resources, with no external funding available. Publisher Copyright: © 2023, The Author(s).

PY - 2024

Y1 - 2024

N2 - Background: The prolonged air leak is probably the most common complication following lung resections. Around 10–20% of the patients who undergo a lung resection will eventually develop a prolonged air leak. The definition of a prolonged air leak varies between an air leak, which is evident after the fifth, seventh or even tenth postoperative day to every air leak that prolongs the hospital stay. However, the postoperative hospital stay following a thoracoscopic lobectomy can be as short as 2 days, making the above definitions sound outdated. The treatment of these air leaks is also very versatile. One of the broadly accepted treatment options is the autologous blood pleurodesis or “blood patch”. The purpose of this trial is to investigate the impact of a prophylactic autologous blood pleurodesis on reducing the duration of the postoperative air leak and therefore prevent the air leak from becoming prolonged. Methods: Patients undergoing an elective thoracoscopic anatomic lung resection for primary lung cancer or metastatic disease will be eligible for recruitment. Patients with an air leak of > 100 ml/min within 6 h prior to the morning round on the second postoperative day will be eligible for inclusion in the study and randomization. Patients will be randomized to either blood pleurodesis or watchful waiting. The primary endpoint is the time to drain removal measured in full days. The trial ends on the seventh postoperative day. Discussion: The early autologous blood pleurodesis could lead to a faster cessation of the air leak and therefore to a faster removal of the drain. A faster removal of the drain would relieve the patient from all the well-known drain-associated complications (longer hospital stay, stronger postoperative pain, risk of drain-associated infection, etc.). From the economical point of view, faster drain removal would reduce the hospital costs as well as the costs associated with the care of a patient with a chest drain in an outpatient setting. Trial registration: German Clinical Trials Register (DRKS) DRKS00030810. 27 December 2022.

AB - Background: The prolonged air leak is probably the most common complication following lung resections. Around 10–20% of the patients who undergo a lung resection will eventually develop a prolonged air leak. The definition of a prolonged air leak varies between an air leak, which is evident after the fifth, seventh or even tenth postoperative day to every air leak that prolongs the hospital stay. However, the postoperative hospital stay following a thoracoscopic lobectomy can be as short as 2 days, making the above definitions sound outdated. The treatment of these air leaks is also very versatile. One of the broadly accepted treatment options is the autologous blood pleurodesis or “blood patch”. The purpose of this trial is to investigate the impact of a prophylactic autologous blood pleurodesis on reducing the duration of the postoperative air leak and therefore prevent the air leak from becoming prolonged. Methods: Patients undergoing an elective thoracoscopic anatomic lung resection for primary lung cancer or metastatic disease will be eligible for recruitment. Patients with an air leak of > 100 ml/min within 6 h prior to the morning round on the second postoperative day will be eligible for inclusion in the study and randomization. Patients will be randomized to either blood pleurodesis or watchful waiting. The primary endpoint is the time to drain removal measured in full days. The trial ends on the seventh postoperative day. Discussion: The early autologous blood pleurodesis could lead to a faster cessation of the air leak and therefore to a faster removal of the drain. A faster removal of the drain would relieve the patient from all the well-known drain-associated complications (longer hospital stay, stronger postoperative pain, risk of drain-associated infection, etc.). From the economical point of view, faster drain removal would reduce the hospital costs as well as the costs associated with the care of a patient with a chest drain in an outpatient setting. Trial registration: German Clinical Trials Register (DRKS) DRKS00030810. 27 December 2022.

KW - Blood patch

KW - Lobectomy

KW - Lung surgery

KW - Pleurodesis

KW - Prolonged air leak

KW - Segmentectomy

U2 - 10.1186/s13063-023-07875-z

DO - 10.1186/s13063-023-07875-z

M3 - Journal article

C2 - 38166982

AN - SCOPUS:85181257024

VL - 25

JO - Trials

JF - Trials

SN - 1745-6215

M1 - 20

ER -