Early Approach to Primary Spontaneous Pneumothorax Treatment in Children

Year 2022, Volume: 16 Issue: 6, 501 - 506, 30.11.2022

Hayriye Nihan Karaman Ayyıldız , Ceyhan Şahin , Mehmet Arpacık , Zeliha Akış Yıldız , Semih Lütfi Mirapoğlu , Fatma Tuğba Güvenç , Aysel Yucak Özdemir Zekeriya İlce , Aytekin Kaymakcı

https://doi.org/10.12956/tchd.1014249

Abstract

Objective: Etiology, diagnosis, and treatment of primary spontaneous pneumothorax (PSP) are not well-established and subject to debate in the pediatric age group. Our study aims to clarify the subject and discuss it in the light of available literature.

Material and Methods: We performed a retrospective analysis of the age, sex, etiology, smoking habits, diagnostic methods, pneumothorax percentages, first treatment approach, and treatment results of the patients with PSP by examining the patients’ records. A total of 71 patients, 65 (91.5%) male and six (8.5%) female, who were followed up and treated between 2010 and 2020 were included in the study. Descriptive statistical methods, Shapiro-Wilk test Mann-Whitney U test, Pearson chi-square test, Fisher’s exact test, Fisher-Freeman-Halton exact test were used while evaluating the study data.

Results: The mean age of the patients was 16.23±0.81 (13–18 years). The etiology was not clear in most of the patients. However, among them, 14 (25.5%) patients had bullae and 23 (32.4%) patients had a smoking habit. The diagnosis was made by means of taking medical history, physical examination, and post-anterior (PA) chest X-ray. Treatment with nasal oxygen was initiated in 14 (19.7%) patients with a pneumothorax percentage <20%. For a total of 57 patients the first line of treatment was initiated with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed in cases where tube thoracostomy failed.

Conclusion: Different forms of initial treatment modalities exist for spontaneous pneumothorax. However, we suggest that the first option in patients of the pediatric age group should be clinical follow-up and supportive treatment, if necessary, tube thoracostomy should be applied.

Keywords

primary spontaneous pneumothorax, nonoperative, recurrence, pediatric

Çocuklarda Primer Spontan Pnömotoraks Tedavisinde Erken Yaklaşım

Abstract

Amaç: Çocuk yaş grubunda Primer Spontan Pnömotoraks (PSP) etyolojisi, tanı ve tedavisi henüz kesinleşmemiş ve tartışmalı bir konudur. Makalemizde konuya açıklık getirme ve literatür eşliğinde tartışılması amaçlanmıştır.

Gereç ve Yöntemler: “Primer Spontan Pnömotoraks (PSP) nedeniyle takip ve tedavi ettiğimiz hastaların yaş, cinsiyet, etyoloji, sigara alışkanlıkları, tanı yöntemleri, pnömotoraks oranları, ilk tedavi yaklaşımımız ve sonuçları hastaların kayıtları incelenerek değerlendirildi. 2010-2020 yılları arasında takip ve tedavi edilen 65’i (%91.5) erkek, 6’sı (%8.5) kız, toplam 71 hasta çalışmaya alındı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodlar, Shapiro-Wilk testi, Mann-Whitney U test, Pearson ki-kare test, Fisher’s exact test, Fisher-Freeman-Halton exact test kullanıldı.

Bulgular: Hastaların yaş ortalaması 16.23±0.81 (13–18 years)’di. Hastaların çoğunda etyoloji belli değildi. Ancak 14 (%25.4) hastada bül saptanırken, 23 (%32.4) hastanın hikayesinde sigara içme alışkanlığı saptandı. Tanı, hikâye, fizik muayene ve PA Akciğer grafisi ile kondu. Pnömotoraks oranı %20’nin altında olan 14 (%19.7) hastaya nazal oksijen ile tedaviye başlandı. Toplam 57 hastaya ilk tedavi olarak tüp torakostomi uygulandı. Tüp torakostominin başarısız olduğu olgulara video yardımlı torakoskopik cerrahi (VATS) uygulandı.

Sonuç: Spontan pnömotoraks başlangıç tedavi yöntemleri arasında farklı uygulamalar mevcuttur. Ancak çocuklarda ilk seçenek klinik takip ve destek tedavisi gerekirse tüp torakostomi uygulaması şeklinde olmalıdır. Bu uygulamalar kolay, başarı oranı yüksek, güvenli ve etkili bir tedavi yöntemidir. İleri cerrahi uygulamalar seçilmiş olgularda yapılmalıdır.

Keywords

Primer Spontan Pnömotoraks, nonoperatif, nüks, çocuk

References

• Dotson K, Johnson LH. Pediatric spontaneous pneumothorax. Pediatr Emerg Care 2012;28:715-720; quiz 21-23.
• Lee LP, Lai MH, Chiu WK, Leung MW, Liu KK, Chan HB, et al. Management of primary spontaneous pneumothorax in Chinese children. Hong Kong Med J 2010;16:94-100.
• Soccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: Radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int 2015;31:1139-44.
• Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: Is primary surgery the treatment of choice? Am J Surg 2014;208:571-6.
• Chiu CY, Chen TP, Wang CJ, Tsai MH, Wong KS. Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients. Eur J Pediatr 2014;173:1483-90.
• Ilce Z, Gündogdu G, Kara C, Ilikkan B, Celayir S. Which patients are at risk? Evaluation of the morbility and mortality in newborn pneumothorax. Indian Pediatr 2003;40:325-8.
• Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of pediatric primary spontaneous pneumothorax. Pediatr Respir Rev 2009;10:110-7.
• Williams K, Oyetunji TA, Hsuing G, Hendrickson RJ, Lautz TB. Spontaneous pneumothorax in children: National Management Strategies and Outcomes. J Laparoendosc Adv Surg Tech A 2018;28:218-22.
• Laituri CA, Valusek PA, Rivard DC, Garey CL, Ostlie DJ, Snyder CL, et al. The utility of computed tomography in the management of patients with spontaneous pneumothorax. J Pediatr Surg 2011;46:1523-5.
• O’Lone E, Elphick HE, Robinson PJ. Spontaneous pneumothorax in children: When is invasive treatment indicated? Pediatr Pulmonol 2008;43:41-6.
• Choi SY, Kim YH, Jo KH, Kim CK, Park JK, Cho DG, et al. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Pediatr Surg Int 2013;29:505-9.
• Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590-602.
• MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(Suppl. 2):ii18-31.
• Light R. Pleural diseases. 3rd ed. Philadelphia: Lea & Febinger; 1990;331.
• Shih CH, Yu HW, Tseng YC, Chang YT, Liu CM, Hsu JW, et al. Clinical manifestations of primary spontaneous pneumothorax in pediatric patients: An analysis of 78 patients. Pediatr Neonatol 2011;52:150-4.
• Zganjer M, Cizmić A, Pajić A, Cigit I, Zganjer V. Primary spontaneous pneumothorax in pediatric patients: Our 7-year experience. J Laparoendosc Adv Surg Tech A 2010;20:195-85.
• Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 1987;92:1009- 12.
• Chiu HY, Hsiao KF, Huang SC, Tsai LY, Lin CY. Clinical study of primary spontaneous pneumothorax in children. Changhua J Med 2005;10:82-5.
• Williams K, Lautz TB, Leon AH, Oyetunji TA. Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. J Pediatr Surg 2018;53:1858-61.
• Williams K, Baumann L, Grabowski J, Lautz TB. Current Practice in the management of spontaneous pneumothorax in children. J Laparoendosc Adv Surg Tech A 2019;29:551-6.