Fifteen-minute consultation: A structured approach to a child with primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) is an uncommon presentation in children but may occur at any age and occurs in patients with no pre-existing lung disease. Management aims are to re-expand the collapsed lung, relieve pressure in the intrapleural space and avoid a tension pneumothorax. Correct management of PSP will avoid unnecessary intervention, reduce length of hospital stay and also reduce the risk of recurrence. There are no established guidelines for treating PSP in children and there is significant variation in management among centres and clinicians. This article provides a clear, evidence-based and structured approach to assessment and management of PSP in children and young people.

Download Full-text

Pneumothorax

Emergencies in Respiratory Medicine ◽

10.1093/med/9780199202447.003.0026 ◽

2007 ◽

pp. 161-170

Keyword(s):

Treatment Response ◽

Spontaneous Pneumothorax ◽

Tension Pneumothorax ◽

Pleural Space ◽

Response To Therapy ◽

Primary Spontaneous Pneumothorax ◽

Acute Presentation ◽

Secondary Spontaneous Pneumothorax

Definitions 162 Primary spontaneous pneumothorax (PSP) 162 Secondary spontaneous pneumothorax (SSP) 162 Acute presentation 163 Tension pneumothorax 164 Investigations 165 Management 166 Complications 167 Pneumothorax is defined as air in the pleural space. It may occur as a result of trauma or spontaneously, in which case it is further subdivided into primary and secondary. The treatment, response to therapy, and prognosis in these two groups is quite different, and establishing the category is essential....

Download Full-text

Evidence-based management of paediatric primary spontaneous pneumothorax

Paediatric Respiratory Reviews ◽

10.1016/j.prrv.2008.12.003 ◽

2009 ◽

Vol 10 (3) ◽

pp. 110-117 ◽

Cited By ~ 47

Author(s):

Paul D. Robinson ◽

Peter Cooper ◽

Sarath C. Ranganathan

Keyword(s):

Spontaneous Pneumothorax ◽

Primary Spontaneous Pneumothorax ◽

Evidence Based

Download Full-text

Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

BMC Surgery ◽

10.1186/s12893-021-01426-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephen Fung ◽

Hany Ashmawy ◽

Sami Safi ◽

Anja Schauer ◽

Alexander Rehders ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Chest Tube ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Length Of Hospital Stay ◽

Operation Time ◽

Postoperative Outcome ◽

Primary Spontaneous Pneumothorax ◽

Recurrence Rates

Abstract Background Two-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited. Methods From January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups. Results Clinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274). Conclusion Our data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

Download Full-text

Pneumothorax

10.1093/med/9780199568741.003.0131 ◽

2018 ◽

Author(s):

Saifudin Khalid ◽

Rowland J. Bright-Thomas ◽

Seamus Grundy

Keyword(s):

Lung Disease ◽

Spontaneous Pneumothorax ◽

Tension Pneumothorax ◽

Pleural Space ◽

Primary Spontaneous Pneumothorax ◽

Medical Emergency ◽

Secondary Spontaneous Pneumothorax ◽

Mediastinal Shift ◽

Lung Condition

Pneumothorax is defined as the presence of air within the pleural space. Pneumothoraces are divided into spontaneous and traumatic categories, depending on the presence or absence of preceding trauma. Spontaneous pneumothoraces are subclassified as primary or secondary: a primary spontaneous pneumothorax (PSP) occurs in a person without underlying lung disease, whereas a secondary spontaneous pneumothorax (SSP) takes place in a person who has an underlying lung condition such as COPD or asthma. Tension pneumothorax is a medical emergency where air entering the pleural space on inspiration is unable to escape on expiration, causing mediastinal shift and cardiovascular compromise.

Download Full-text