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Primary Spontaneous Pneumothorax
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The Society of Thoracic Surgery recommends primary aspiration for spontaneous pneumothorax in adult patients. — Dan Ostlie, Spontaneous Pneumothorax · 9:33
Spontaneous Pneumothorax
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This podcast is an interactive discussion about the management of spontaneous pneumothorax between Dr. Todd Ponsky and Dr. Dan Ostlie. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmi
podcast33:31 · Dec 2020
The most important change in updated APSA guidelines is that discharge of solid organ injury patients is not related to severity of injury but to clinical condition of the patient. — Regan Williams, Journal of Pediatric Surgery Article REview: August Issue 2023 · 9:34
Journal of Pediatric Surgery Article REview: August Issue 2023
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 4 articles from August 2023 issue, with editor Dr. Holcomb, the expert Dr. Di Fiore and authors Drs. Krista Lai, Rega
podcast17:30 · Feb 2024
Almost all patients with spontaneous pneumothorax have bleb disease whether it is defined early or not. — Mark, Spontaneous Pneumothorax: Lung Lesions · 13:14
Spontaneous Pneumothorax: Lung Lesions
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Dr. Mark McCollum leads a discussion in the management of spontaneous pneumothorax, including the type of anesthesia for chest tube insertion, indications for CT scans, number of ports in VATS, recurrence of bilateral blebs, and different t
video22:21 · Jan 2019
Expert statements from the recordings in this collection.
Spontaneous Pneumothorax: Lung Lesions
There is disagreement in the literature on management of primary spontaneous pneumothorax, with no clear evidence supporting any particular approach.
The majority of children at their institution elect to undergo general anesthesia rather than bedside chest tube placement under local anesthesia.
Mark6:23
50% of patients who undergo chest tube placement or observation for pneumothorax will have recurrence and need additional intervention.
Mark6:43
Among patients with bleb disease who undergo simple chest tube placement for symptomatic pneumothorax, upwards of 50% will recur.
Mark7:27
Second recurrence rate is approximately 75%.
Mark8:03
No study has separated patients on first event into those with blebs versus no blebs and examined risk of second event recurrence.
Mark8:23
A CT scan is not very effective for visualizing blebs when the lung is partially collapsed.
Mark8:45
Almost all patients with spontaneous pneumothorax have bleb disease whether it is defined early or not.
Bleb disease does not necessarily mean recurrence will occur.
Patients with spontaneous pneumothorax usually recur when at home, not in remote locations or extremis.
Mark14:41
A recent study from Saint Peter in Kansas City found CT scan was very poor at defining bleb disease compared to subsequent thoracoscopy.
More people are using chemical pleurodesis instead of mechanical pleurodesis and finding better results, shorter OR times, and decreased recurrence rates.
There is still a pretty high recurrence rate even after VATS with blebectomy and mechanical or chemical pleurodesis.
Mark19:08
In Argentina, for stable patients with pneumothorax, they place a thin double pigtail catheter percutaneously with local anesthesia, attached to a Heimlich valve.
Marcello9:04
Most patients with spontaneous pneumothorax are adolescents (around 18 years old).
Marcello5:12
Aerosolized talc can be administered through a chest tube, creating a 'snow' effect inside the chest for pleurodesis.
Todd20:03
Apical pleurectomy causes more postoperative pain than talc pleurodesis.
Talc pleurodesis creates random massive chemical pleurodesis throughout the chest, which may complicate future thoracic surgery.
Apical pleurectomy is limited to the apex of the lung, typically down to the third intercostal space when apical blebs are present.
When no blebs are visible on thoracoscopy, the apex can be sealed with a ligature and apical pleurectomy performed.
Hydrostatic pleurectomy technique involves making a small pleural incision, inserting a suction irrigator, sealing around it, and irrigating to dissect the entire pleura, which can then be rolled up and removed.
Mark20:48
Hydrostatic pleurectomy can achieve hemi-thorax pleural removal, more extensive than apical pleurectomy alone.
Mark21:11
After unilateral treatment of symptomatic pneumothorax, recurrence can occur on the contralateral side during the immediate postoperative period.
Giovanna17:51
Journal of Pediatric Surgery Article REview: August Issue 2023
Phoenix Children's Hospital study compared first quarter versus fourth quarter of cryoablation experience in Nuss procedures, finding 74% less opioid use and 80% of patients achieving early discharge home by postoperative day 2 in the fourth quarter.
DeFiore2:26
Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA.
IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience.
The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique.
Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone.
Kansas City protocol for primary spontaneous pneumothorax involves small catheter placement mimicking aspiration, clamping, and chest X-ray at 6 hours, with success defined as equal or lower than 2 centimeter distance between chest wall and lung at apex and no air leak when clamp released.
In 59 pediatric primary spontaneous pneumothorax patients, aspiration was successful in 33% while 66% still required VATS.
Shawn St. Peter6:15