Primary Spontaneous Pneumothorax in Adolescents and Young Adults | 79 manuscripts were reviewed | Literature review of Spontaneous Pneumothorax cases between 1990 - 2020 | Initial management | Advanced imaging | Timing of surgery | Operative technique | Management of contralateral side | Management of recurrence | No evidence to support | Cross-sectional imaging | Prophylactic management of the contralateral side | Ongoing air leak may benefit from early intervention within 24-48 h | Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment | Conclusion: The treatment of primary spontaneous pneumothorax in young patients varies, requiring more research to optimize surgery timing, methods, and management of recurrences. | https://pubmed.ncbi.nlm.nih.gov/37130765/ | Source: Speck KE et. al. | Mott Children's Hospital, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, USA | APSA Outcomes & Evidence-Based Practice Committee | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults: A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee
Infographic · Jan 2024 · 1 min read
In brief
In brief
APSA systematic review establishes evidence-based guidelines for managing primary spontaneous pneumothorax in adolescents and young adults. Recommends symptom-guided initial treatment, early VATS with blebectomy for persistent air leak, and no prophylactic contralateral intervention. Identifies need for prospective studies on optimal timing and recurrence management.
- Initial management should be symptom-guided: observation, aspiration, or tube thoracostomy are all appropriate first-line options.
- Cross-sectional imaging (CT/MRI) provides no proven benefit in primary spontaneous pneumothorax management.
- Patients with persistent air leak benefit from early VATS intervention within 24-48 hours rather than prolonged conservative management.
- VATS with stapled blebectomy plus pleural procedure is the recommended surgical approach; prophylactic contralateral surgery is not supported.
- Recurrence after VATS can be managed with repeat VATS and intensified pleural treatment rather than converting to thoracotomy.
Written by the GCMD Library team from the infographic.
Four-panel infographic with teal header, dark teal and purple content sections, and yellow conclusion banner. Left panels feature calendar icon and illustrated clinician examining chest X-ray. Right panels display manuscript statistics and clinical findings in bullet format. Bottom includes institutional logos and citation.
K Elizabeth Speck, Afif N Kulaylat, Joanne E Baerg, Shannon N Acker, Robert Baird, Alana L Beres, Henry Chang, S Christopher Derderian, Brian Englum, Katherine W Gonzalez, Akemi Kawaguchi, Lorraine Kelley-Quon, Tamar L Levene, Rebecca M Rentea, Kristy L Rialon, Robert Ricca, Stig Somme, Derek Wakeman, Yasmine Yousef, Shawn D St Peter, Donald J Lucas; APSA Outcomes and Evidence Based Practice Committee
Introduction: Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations.
Methods: Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed.
Results: Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment.
Conclusions: The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention.