title: Efficacy of blood-patch pleurodesis for secondary spontaneous pneumothorax in interstitial lung disease.
abstract: OBJECTIVE
  We identified the prognostic relevance of pneumothorax in interstitial lung disease (ILD) patients and evaluated the efficacy and safety of autologous blood-patch pleurodesis.
  
  
  METHODS
  We retrospectively reviewed 59 occurrences of pneumothorax in 34 ILD patients identified over a 12-year period.
  
  
  RESULTS
  Air leakage ceased in 16 of 22 (72.7%) episodes after blood pleurodesis and in 11 of 14 (78.6%) episodes after chemical pleurodesis. Both the cure ratio and recurrence ratio in the cure episodes were comparable with those in the chemical pleurodesis group (p=0.99 and 0.99, respectively). In addition, there were no harmful events associated with blood pleurodesis. The median survival time after the first episode of pneumothorax was less than 9 months in patients with idiopathic interstitial pneumonia (IIP) and only around 3 years in the patients with other types of ILD, which have essentially favorable outcomes. Kaplan-Meier survival estimates were significantly worse in the patients with concomitant pneumomediastinum than in those without (p<0.05). A multivariate Cox regression analysis identified that the number of episodes of pneumothorax, IIP diagnosis and concomitant pneumomediastinum were independent predictors of death.
  
  
  CONCLUSIONS
  Autologous blood-patch pleurodesis is safe and worth considering as a first-line treatment for pneumothorax secondary to ILD. However, despite treatments, the prognosis after the onset of pneumothorax in ILD patients was found to be poor. In addition, concomitant pneumomediastinum may further worsen the prognosis.
authors.affiliation: Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Aihara
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Handa
authors.forename: Sonoko
authors.initials: S
authors.lastname: Nagai
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Tanizawa
authors.forename: Kizuku
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yuka
authors.initials: Y
authors.lastname: Harada
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Chihara
authors.forename: Takefumi
authors.initials: T
authors.lastname: Hitomi
authors.forename: Toru
authors.initials: T
authors.lastname: Oga
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Tsuboi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053208:Kaplan-Meier Estimate; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome