Comparison of 40% Glucose Solution and Autologous Blood Patch Pleurodesis for Postoperative Air Leak After Lung Resections: Prospective Randomized Study

Status: Recruiting
Location: See location...
Intervention Type: Procedure
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Prolonged or persistent air leak (PAL) is one of the most common complications in patients after surgery on the lung parenchyma. Air leaks typically originate from alveolar-pleural fistulas, which can result from surgical manipulation of the lung parenchyma or the bronchial stump after procedures such as lobectomy. Key risk factors for PAL include extensive lung resections such as lobectomy, presence of pleural adhesions, incomplete interlobar fissures, chronic obstructive pulmonary disease (COPD), asthma, emphysema, advanced age, and reduced preoperative lung function, particularly low preoperative FEV1 values. PAL necessitates extended pleural drainage, leading to significant patient discomfort, pain, and substantial limitations in early postoperative rehabilitation. In patients with pre-existing pulmonary conditions like bronchial asthma or COPD, PAL can markedly worsen clinical status, resulting in severe complications such as infections, pneumonia, pleural empyema, acute respiratory distress syndrome, and even mortality. In extreme cases, PAL may contraindicate chemotherapy, causing significant delays in adjuvant therapy post-surgery. Effective management of PAL can significantly enhance patient quality of life, facilitating a quicker return to normal activities and continuation of systemic treatment. Moreover, PAL is a leading cause of extended hospitalization, invariably increasing treatment costs. Therefore, the necessity for safe and effective treatment of PAL is justified not only medically but also economically. Current standards for PAL treatment encompass both surgical and non-surgical methods. The available literature describes various conservative treatments, among which pleurodesis is commonly employed. Non-surgical pleurodesis techniques include the intrapleural administration of the patient's autologous blood or chemical agents such as medical talc, povidone-iodine, or doxycycline. Intrapleural administration of autologous blood, known as autologous blood patch pleurodesis (ABPP), is widely utilized for the conservative treatment of PAL. This method involves injecting the patient's own blood into the pleural space through an existing chest tube, promoting clot formation and sealing of the air leak. Studies have demonstrated the safety and efficacy of ABPP, with success rates exceeding 80% in sealing air leaks within 48 hours and a low incidence of complications such as fever or empyema. Another method highlighted in limited scientific literature is the intrapleural administration of a 50% glucose solution. This technique has been primarily reported by authors from Asian countries, such as Japan and Korea, and is not widely adopted in Western centers. Available studies emphasize its effectiveness, with success rates exceeding 80%, and report a lack of complications in patients undergoing pleurodesis with concentrated glucose solutions. The aim of our study is to compare the effectiveness of a 40% glucose solution with the ABPP. The selection of a 40% glucose solution is due to the unavailability of a 50% glucose solution in the Polish pharmaceutical market. Potential benefits of effective PAL treatment include improved patient quality of life, reduced hospitalization duration, decreased risk of complications, and lower treatment costs. Prolonged hospitalization and treatment associated with PAL generate significant expenses for the healthcare system. Our study may contribute to significant improvements in treatment outcomes, patient quality of life, and the cost-effectiveness of thoracic surgical procedures. In the long term, this research may also influence the development of new treatment standards and clinical protocols.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Age: patients aged 18 years or older.

• Surgical Procedure: patients who underwent anatomical lung resections (segmentectomy, lobectomy, or bilobectomy) at the Department of Thoracic Surgery, Poznan University of Medical Sciences, between November 2023 and December 2024.

• Prolonged Air Leak Diagnosis: patients with diagnosed PAL after lung resection, as defined by air leakage persisting beyond 5 days post-surgery.

• Consent: patients who were willing to provide informed consent for participation in the study and for the intervention procedures (autologous blood pleurodesis or 40% glucose solution pleurodesis).

Locations
Other Locations
Poland
Wielkopolskie Centrum Pulmonologii i Torakochirurgii
RECRUITING
Poznan
Contact Information
Primary
Piotr Jerzy Skrzypczak, MD
piotr.j.skrzypczak@gmail.com
+48661962498
Time Frame
Start Date: 2023-12-22
Estimated Completion Date: 2027-05
Participants
Target number of participants: 200
Treatments
Active_comparator: Control group: patients with PAL in whom pleurodesis was performed using autologous blood (ABPP).
After obtaining informed consent, the patient will lie supine in their room. 30 minutes before the procedure, the patient's capillary blood glucose level will be measured. The patient does not have to fast before the procedure. The nurse will be asked to collect 120 ml of peripheral venous blood from the patient. Then the doctor, assisted by the nurse, will first administer 20 ml of 1% Lignocaine through the pleural drain, and then after about 5-10 minutes, the patient's previously collected venous blood. At the moment of blood administration, the drainage system will be disconnected. Then, the drain will be injected with 20 ml of air to avoid clogging the drain. The patient will remain supine for two hours post-procedure, maintaining fasting status. After 30 minutes from the administration of the patient's own blood, the capillary blood glucose level will be measured again. After two hours, the patient, with nursing assistance, may resume normal activities.
Experimental: Study group: Patients in whom pleurodesis was performed using a 40% glucose solution.
After obtaining informed consent, the patient will lie supine in their room. Thirty minutes prior to the procedure, a capillary blood glucose measurement will be taken; fasting is unnecessary. Initially, 20 ml of 1% lignocaine will be administered via the pleural drain. After a 5-10 minute interval, 120 ml of a 40% glucose solution (Glucose 40 B. Braun 400 mg/ml for infusion, Ecoflac Plus) will be infused using two separate Luer Lock syringes to prevent cross-contamination. At the time of glucose administration, the drainage system will be temporarily disconnected. Subsequently, 20 ml of air will be introduced into the drain to prevent occlusion. The patient will remain supine and refrain from sitting or rotating for two hours post-procedure, maintaining fasting status. Capillary blood glucose will be re-assessed 30 minutes after glucose administration. After two hours, the patient, with nursing assistance, may resume normal activities.
Sponsors
Leads: Wielkopolskie Centrum Pulmonologii i Torakochirurgii
Collaborators: Poznan University of Medical Sciences

This content was sourced from clinicaltrials.gov