Update in management of paediatric primary spontaneous pneumothorax

Lieu, Nathan; Ngo, Peter; Chennapragada, S. Murthy; Fitzgerald, Dominic A.; Karpelowsky, Jonathan; Pandit, Chetan; Selvadurai, Hiran; Robinson, Paul D.

doi:10.1016/j.prrv.2021.08.001

Cited by 3 publications

(13 citation statements)

References 21 publications

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“…In real‐life, we have observed that hospitalisation took place in different surgical or medical wards, managed by different paediatric or adult teams. This may partly explain the heterogeneous management of PSP we have noted but that has also been reported in the literature 6,7 …”

Section: Discussionsupporting

confidence: 53%

“…Our proportion of patients experimenting needle aspiration is about 10‐fold lower than for the cohort of Nathan 9 . Surgical management has only consisted in VATS, as recommended, in a previously reported range (17.5 to 48%) 2,6,7,27,28 . In adults, VATS clearly decreases bleeding volume, chest tube removal time and length of stay compared to other surgical techniques used for managing PSP 29 …”

Section: Discussionmentioning

confidence: 91%

“…A clinically stable patient, with no pneumothorax enlargement may be safely discharged, with a control visit planned in the following 48 h. For patients with PSP and tachycardia, tachypnoea or hypotension air evacuation with either needle aspiration or chest tube is needed, and in case of failure of an initial attempt at needle aspiration a second attempt should be performed. Whereas a more conservative approach is suggested, 2,6,7 our management can be qualified as too invasive. Recently, a randomised controlled trial has demonstrated that, whereas lung re‐expansion within 8 weeks was as fast as with observation alone, drainage management increased the rate of serious adverse events and the length of stay 26 …”

Section: Discussionmentioning

confidence: 99%

“…9 Surgical management has only consisted in VATS, as recommended, in a previously reported range (17.5 to 48%). 2,6,7,27,28 In adults, VATS clearly decreases bleeding volume, chest tube removal time and length of stay compared to other surgical techniques used for managing PSP. 29 Recurrence concerns half of our population within a median delay of 4 months (4.5 to 5 months in literature).…”

Section: Discussionmentioning

confidence: 99%

“…2 Diagnosis of PSP is usually evident, but the underlying pathophysiology is still hypothetic, and the best management to adopt is clearly not consensual. [2][3][4][5][6][7] Procedures regarding early diagnosis, chest CT-scan indication, therapy, and PSP recurrence prevention are highly variable and centre dependent, particularly in paediatric patients. In adults, guidelines, like that of the British Thoracic Society…”

mentioning

confidence: 99%

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Management of primary spontaneous pneumothorax in teenagers: An 11‐year study

et al. 2021

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Idiopathic or primary spontaneous pneumothorax (PSP) is the accumulation of air in the pleural space that is not triggered by any trauma or invasive procedure, mechanical ventilation or pulmonary infection. 1 PSP prevalence is estimated between 16 and 52 cases per 100,000 persons, with most cases noted before the age of 23 years, and more particularly in tall and fine male adolescents around 16.3 years. 2 Diagnosis of PSP is usually evident, but the underlying pathophysiology is still hypothetic, and the best management to adopt is clearly not consensual. [2][3][4][5][6][7] Procedures regarding early diagnosis, chest CT-scan indication, therapy, and PSP recurrence prevention are highly variable and centre dependent, particularly in paediatric patients. In adults, guidelines, like that of the British Thoracic Society

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Management of primary spontaneous pneumothorax in teenagers: An 11‐year study

et al. 2021

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Conservative and operative management of spontaneous pneumothorax in children and adolescents: Are we abusing of CT?

Zarfati,

Pardi,

Frediani

et al. 2023

Pediatric Pulmonology

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BackgroundNo age‐specific pediatric guidelines exist for the management of spontaneous pneumothorax (SP) in children and adolescents. Treatment remains heterogeneous and center dependent. The role of computed tomography (CT) has yet to be defined.AimsReview the management of SP in children and adolescents, with emphasis on conservative management and role of CT.MethodsRetrospective analysis of 61 consecutive patients with SP at single tertiary center. Clinical, radiological, surgical data, follow‐up, and outcomes were revised.ResultsFirst‐line management was conservative for 32 (53%) patients and operative for 29 (47%). Asymptomatic/paucisymptomatic patients managed conservatively experienced less first‐line treatment failure. Furthermore, the patients needing at least a chest drain or surgery during the follow‐up were significantly lower in the conservative group. Conservative and operative patients showed no significant differences regarding ipsilateral recurrences or contralateral occurrences. Of the 61 overall CTs performed, 14 (23%) had an impact on management. Forty‐three (70%) patients had at least a CT, in 22 (51%) the CT was positive for blebs. For 10 of these patients (45%) the presence of blebs had an impact on management. Patients with and without blebs showed no differences regarding ipsilateral recurrence, contralateral occurrences, or the need for at least a chest drain or surgery during the follow‐up.ConclusionsFirst‐line conservative management had a significantly shorter hospitalization and better outcome, with a similar incidence of recurrences. The presence of blebs at CT does not predict the risk of recurrence. The CT scan should be reserved for a small number of selected patients who have post‐VATS refractory or recurrent pneumothorax.

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