Management of Primary Spontaneous Pneumothorax in Children

Part of Pediatric Surgical Outcomes 11 items

Infographic · Oct 2023 · 1 min read

In brief

Single-institution study evaluating MWPSC aspiration protocol for primary spontaneous pneumothorax in adolescents found 33% success rate with aspiration alone, while 66% required VATS. Early VATS reduced hospital stay (3.1 vs 6.0 days) and recurrence rates (25% vs 45%) compared to aspiration.

Simple aspiration succeeded in only 33% of pediatric PSP cases; 66% required VATS for definitive management.
Early VATS reduced hospital stay to 3.1 days vs 6.0 days with chest tube after failed aspiration.
Recurrence after aspiration was 45% vs 25% after VATS, occurring much sooner (17 days vs 390 days).
Protocol: aspirate with ≤12F tube, clamp at 6h, advance to VATS if >2cm apical distance or persistent air leak.
Early VATS may be preferable to aspiration-first approach given high failure and recurrence rates in children.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and surgical intervention site, accompanied by statistical data boxes below. The design uses a clean, clinical color palette with icons and percentage indicators for outcomes.

New infographic by Dr. Cecilia Gigena

"Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis"

Authors: Shai Stewart, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St. Peter

Full Article: https://gcmd.co/46nRr7X

Background

The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol.

Methods

A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed.

Results

Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01].

Conclusion

Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity.

The text in the image

Read it at the source ↗