European Pediatric Surgeons' Association Survey on the Management of Primary Spontaneous Pneumothorax in Children

2021 ◽  
Author(s):  
Tutku Soyer ◽  
Anne Dariel ◽  
Jens Dingemann ◽  
Leopoldo Martinez ◽  
Alessio Pini-Prato ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Chest Tube ◽  
Open Surgery ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
First Episode ◽  
Tube Insertion ◽  
Recurrent Pneumothorax ◽  
Chest Tube Insertion ◽  
Pleural Abrasion

Abstract Aim To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children. Methods An online survey was distributed to all members of EUPSA. Results In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery (p < 0.05). Conclusion Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.

scholarly journals Management and recurrence of spontaneous pneumothorax in children

2019 ◽  
Vol 25 (2) ◽  
pp. 86-92
Author(s):  
Martin Gariépy ◽  
Mona Beaunoyer ◽  
Marie-Claude Miron ◽  
Jocelyn Gravel
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
First Episode ◽  
Tube Insertion ◽  
Paediatric Hospital ◽  
Chest Tube Insertion ◽  
Standardized Report

Abstract Objective No guideline clearly prescribes an approach to management of spontaneous pneumothorax in children. The objectives of this study were to evaluate practice variation in the management of spontaneous pneumothorax in children and its probability of recurrence. Methods This study was a retrospective chart review followed by a phone follow-up that included all children who had visited a tertiary care paediatric hospital for a first episode of spontaneous pneumothorax between 2008 and 2017. The primary outcomes were the management of pneumothorax (observation, oxygen, needle aspiration, intercostal chest tube, surgery) and the probability of recurrence. All charts were evaluated by a rater using a standardized report form and 10% of the charts were evaluated in duplicate. All children/families were contacted by phone to assess recurrence. The primary analyses were the proportions of each treatment modalities and recurrence, respectively. Results During the study period, 76 children were deemed eligible for the study. Among them, 59 had a primary spontaneous pneumothorax while 17 were secondary. The most common first therapeutic approaches were chest tube insertion (31), oxygen alone (27), and observation (14). A total of 54 patients were available for follow-up among whom a recurrence was observed in 28 (37% of the total cohort or 52% of available children). Conclusion Chest tube insertion was the first line of treatment in about 40% of children with a first spontaneous pneumothorax. In this population, the recurrence probability is established between 37 and 52% and the majority occurs in the following months.

IS THERE A NEED FOR ANTIBIOTIC USAGE FOLLOWING CHEST TUBE INSERTION IN PRIMARY SPONTANEOUS PNEUMOTHORAX?

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 132S
Author(s):  
Volkan Kara ◽  
Zeki Gunluoglu ◽  
Adalet Demir ◽  
Baris Medetoglu ◽  
Huseyin Melek ◽  
...  
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Antibiotic Usage ◽  
Primary Spontaneous Pneumothorax ◽  
Tube Insertion ◽  
Chest Tube Insertion

Differential Outcome of Fissure-positioned Tube in Closed Thoracostomy for Primary Spontaneous Pneumothorax

2015 ◽  
Vol 81 (5) ◽  
pp. 463-466
Author(s):  
Yong Won Kim ◽  
Chun Sung Byun ◽  
Yong Sung Cha ◽  
Oh Hyun Kim ◽  
Kang Hyun Lee ◽  
...  
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Pleural Space ◽  
Primary Spontaneous Pneumothorax ◽  
Tube Placement ◽  
Symptom Duration ◽  
Tube Insertion ◽  
Chest Tube Placement ◽  
Chest Tube Insertion ◽  
Significant Difference

Closed tube thoracostomy is often used to evacuate a primary spontaneous pneumothorax (PSP). Occasionally, this procedure is complicated by placement of the chest tube location in the fissural area instead of pleural space. There is a paucity of studies on outcomes according to chest tube placement. As such, we investigated outcomes of chest tube placement in fissural versus pleural area in closed thoracostomy for PSP. Patients between 14 and 65 years of age who had been treated with chest tube insertion to evacuate PSP were selected based on retrospective review of medical records. Patients selected for this study received chest tube placement at either the fissural or pleural spaces. Those with pre-existing lung disease or those transferred into our hospital after closed thoracostomy were excluded. Of the 255 patients with PSP treated with chest tube insertion, 172 patients were enrolled in this study. Twenty-nine (16.9%) had fissural tube placement and 143 (83.1%) had pleural tube placement. A higher proportion of patients in the fissural versus pleural group required additional chest tube insertion (20.7% vs 4.9%, P = 0.010, respectively). There was no significant difference in body mass index, smoker status, symptom duration, number of episodes, post-thoracostomy complications, need for subsequent management, and duration of hospitalization in either group. In closed thoracostomy for PSP, there is a higher chance of tube dysfunction when the chest tube is positioned at fissural area as compared with the pleural space.

scholarly journals Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Yomi Fashola ◽  
Sanjeev Kaul ◽  
Douglas Finefrock
Keyword(s):  
Elderly Patient ◽  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Rare Complication ◽  
Tube Thoracostomy ◽  
Shortness Of Breath ◽  
Tube Insertion ◽  
Chest Tube Insertion ◽  
Severe Bradycardia ◽  
Life Threatening

We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.

scholarly journals A Case of Chylothorax Causing to Chest Tube Insertion for Spontaneous Pneumothorax

2013 ◽  
Vol 9 (3) ◽  
pp. 156-159
Author(s):  
Hirotoshi Kubokura ◽  
Masami Otsuka ◽  
Junichi Okamoto ◽  
Jitsuo Usuda
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Tube Insertion ◽  
Chest Tube Insertion

scholarly journals Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

2019 ◽  
Vol 18 (4) ◽  
pp. 239-245
Author(s):  
Matas Mongirdas ◽  
Audrius Untanas ◽  
Žymantas Jagelavičius ◽  
Ričardas Janilionis
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
First Episode ◽  
Air Leak ◽  
Removal Time ◽  
Tube Removal ◽  
Significant Difference ◽  
Chest Tube Removal

Background / objectives. The main treatment option for the first episode of primary spontaneous pneumothorax is chest tube drainage, however, whether delayed chest tube removal might influence the recurrence is unclear.Methods. A prospective study, which included 50 patients, with an initial episode of primary spontaneous pneumothorax was performed. Patients were randomized into two groups according to the chest tube removal time: 1-day and 5-days after the air-leak has stopped. All patients were followed-up for at least six months. Both groups were compared according to the recurrence rate and possible complications.Results. There were 39 (78%) men and the median age was 27 (23–35) years. Successful management with a chest tube was achieved in 43 (86%) patients, others were operated on because of the continuous air-leak or relapse of the pneumothorax after the chest tube was removed. Significant difference was not found comparing groups by age, gender, side, tobacco smoking, alpha-1-antitrypsin level, rate of prolonged air-leak, necessity of surgery, and the mean follow-up time. There was a significant difference between groups in hospitalization time: 1-day group – 6 (4–12), 5-days group – 8 (7–10) days, p = 0.017. Five (20%) patients from 1-day group and 3 (12%) from 5-days group had a recurrence, however the difference was not significant (p = 0.702). There were no significant differences comparing groups by the recurrence time or complications.Conclusions. The recurrence rate of primary spontaneous pneumothorax was higher if the chest tube was removed earlier, however not significantly. More data and longer follow-up are necessary to confirm these findings.

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