Dr. Daniel von Allmen discusses a possible shift in management for patients with spontaneous pneumothorax, as he summarizes "Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax" from the Journal of Pediatric Surgery.
Here's an article you should know about. The Journal of Pediatric Surgery published a study from the Midwest Pediatric Surgery Consortium, looking at the optimal management of spontaneous pneumothorax. In this prospective trial, patients were initially treated with simple air aspiration from the pleural space with a pigtail catheter in the emergency department, followed by 6 hours of observation. If the pneumothorax did not recur, they were sent home. And if it recurred, they were admitted to the hospital. They found that 83% of those who failed the aspiration eventually required a VATS procedure. The recurrence rate of those who were sent home was 44% with no episodes of tension pneumothorax. The authors recommend performing this aspiration protocol, and all patients that fail should go straight to the operating room since the need for the OR is so high in these patients.
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