Management of Primary Spontaneous Pneumothorax in Children
Topic overview
Single-institution study evaluating MWPSC aspiration protocol for primary spontaneous pneumothorax in adolescents found 33% success rate with aspiration alone, while 66% required VATS. Early VATS reduced hospital stay (3.1 vs 6.0 days) and recurrence rates (25% vs 45%) compared to aspiration.
Key takeaways
- 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).
- Protocol: aspirate with ≤12F tube, clamp at 6h, advance to VATS if >2cm apical distance or persistent air leak.
- Early VATS may be preferable to aspiration-first approach given high failure and recurrence rates in children.
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