Management of Primary Spontaneous Pneumothorax in Children | Spontaneous Pneumothorax | Simple aspiration (SA) | Fail | VATS | Success | Discharge | Single institution Retrospective 2016-2021 | RESULTS: | 59 Patients | SA: 33% | VATS: 66% | Length of Stay (LOS) | 20.4 h | 3.1 days | Recurrence rates | 45% | 25% | Conclusion: SA seems a feasible and good initial treatment for spontaneous pneumothorax. If it fails, early VATS should be considered to reduce LOS. | https://www.jpedsurg.org/article/S0022-3468(23)00075-1/fulltext | Source: Stewart S. et al. | Department of Surgery, Children's Mercy Kansas City & University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA | @StayCurrentMD | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
Management of Primary Spontaneous Pneumothorax in Children
Infographic · Oct 2023 · 1 min read
In brief
In brief
Single-institution study evaluating simple aspiration versus VATS for primary spontaneous pneumothorax in adolescents. While aspiration succeeded in 33% of cases, early VATS reduced hospital stay and had lower recurrence rates, suggesting surgical intervention may be preferable for definitive management.
- 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).
- Aspiration-first protocol is safe but most children ultimately need VATS; consider early surgical intervention.
- VATS offers lower recurrence and faster recovery compared to prolonged conservative management in pediatric PSP.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and dark green color scheme with a flowchart at the top showing treatment pathways. Icons include a calendar, syringe, and lung illustration. Results are displayed in two columns comparing simple aspiration (SA) versus VATS outcomes, with key statistics in contrasting colors (cyan for SA, red for VATS). A yellow conclusion box appears on the right side.
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.