Autologous blood patch pleurodesis for persistent air leak in the setting of chronic non-invasive ventilation: case report

Background: Persistent air leaks (PAL) are associated with significant morbidity and mortality, including prolonged length of hospital stays, increased re-admission rates and increased incidences of pneumonia and pleural space infections. Autologous blood patch pleurodesis (ABPP) may be used in the management of PAL, however it is unclear whether this treatment option can be used in patients requiring chronic noninvasive ventilation. Case Description: We discuss a patient with amyotrophic lateral sclerosis (ALS) requiring continuous bi-level positive airway pressure ventilation, who presented to our centre with secondary spontaneous pneumothorax, complicated by a PAL. He was not a candidate for definitive surgical management due to his dependence on chronic non-invasive ventilation, immobility, and poor functional status. After administering five autologous blood patch pleurodeses, the patient's alveolar pleural fistula resolved, and he was discharged home. He has not had recurrence of his pneumothorax with one year of follow-up. With the last successful attempt, he was positioned in an upright sitting position. Conclusions: Our case report suggests that ABPP is an effective and safe treatment for PAL in patients requiring chronic non-invasive ventilation, including patients who are not surgical candidates. The treatment may need to be repeated, and patient positioning may affect outcomes.