It was Robinson who first introduced blood pleurodesis for chronic spontaneous pneumothorax, followed by Dumire some years later, who applied it for persistent pulmonary air leak [
7,
8]. Although fever, pleural effusion and empyema have been reported with this method [
1,
2], there are several other reports that accent it as the safest method of pleurodesis in persistent air leak after pulmonary surgery and spontaneous pneumothorax [
4,
9‐
12]. Numerous other sclerotic agents have been used to produce pleural symphysis with different advantages and drawbacks. From tetracycline and doxycycline, to quinacrine, bleomycin, talc, interferon or even silver nitrate [
13‐
16]. Despite the fact that many surgeons seek the best method of pleurodesis among these sclerotic agents, we consider blood pleurodesis as the safest and most preferable intervention in our case, especially because our sample of patients consisted mostly of minor ages. Our primary goal was to avoid the possible toxic side effects of chemical agents especially in our young patients [
3]. We did not have the expected results, although the technique we followed was adhered to the recommendations of literature. We performed the procedure after seven days of air leak which is the optimal time according to many authors [
2,
8,
9] and we used big sized chest tubes and syringes to avoid catheter obstruction. The volume of blood is a controversial point among different authors. Many perform the pleurodesis by instillation of 50 ml of blood [
2,
5,
12], while others use 120 ml or 150 ml [
4,
10] thus introducing a completely different approach. We preferred the injection of 50 ml only once (with the exception of multi-morbid patients) because minimal exposure of the patients to all infection risks resulting from tubing manipulations was our major concern. In those two ineligible for surgery we considered it appropriate to repeat the method 48 hours after the first attempt, before reaching the final decision for a Heimlich valve. In regard to the other patients, it was their minor mean age that dictated the less aggressive strategy we followed (one attempt). In similar case series success rates vary between 75% [
5] and 84% [
1]. As concerning our success percentage of 27%, we believe that it could possibly be significantly higher should we had applied the method more than once.
Two major points we can comment on from our analysis as it can be clearly extracted from table
1 are: i) the mean age of the patients that were not submitted to surgery was significantly higher than the mean age from the operated ones. This is an expected result considering the multiple comorbidities and risks associated with an increased age. ii) The operated patients had a prolonged hospitalization period compared to the rest of the patients. These findings clearly show that blood pleurodesis, when successful, decreases hospital stay and can be the method of choice for patients not amendable to surgical interventions.