Current Practice in the Management of Spontaneous Pneumothorax in Children

Kibileri Williams, Lauren Baumann, Julia Grabowski, Timothy B. Lautz*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. Materials and Methods: An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. Results: A total of 287 surveys were completed (33% response rate). For a first episode of PSP, 57% of surgeons opt for chest tube drainage, 4% for upfront video-assisted thoracoscopic surgery (VATS), 3% for needle aspiration, and 29% for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40% operating after 3 days, but 21% waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. Conclusion: There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume29
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Practice Management
Pneumothorax
Pediatrics
Video-Assisted Thoracic Surgery
Chest Tubes
Air
Tomography
Observation
Pleurodesis
Practice Guidelines
Needles
Drainage
Thorax
Clinical Trials
Guidelines
Oxygen
Surgeons
Primary Spontaneous Pneumothorax
Surveys and Questionnaires

Keywords

  • pneumothorax
  • spontaneous pneumothorax
  • video-assisted thoracoscopic surgery

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Current Practice in the Management of Spontaneous Pneumothorax in Children",
abstract = "Introduction: There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. Materials and Methods: An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. Results: A total of 287 surveys were completed (33{\%} response rate). For a first episode of PSP, 57{\%} of surgeons opt for chest tube drainage, 4{\%} for upfront video-assisted thoracoscopic surgery (VATS), 3{\%} for needle aspiration, and 29{\%} for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40{\%} operating after 3 days, but 21{\%} waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. Conclusion: There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.",
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Current Practice in the Management of Spontaneous Pneumothorax in Children. / Williams, Kibileri; Baumann, Lauren; Grabowski, Julia; Lautz, Timothy B.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 29, No. 4, 01.04.2019, p. 551-556.

Research output: Contribution to journalArticle

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