Update in management of paediatric primary spontaneous pneumothorax

Nathan Lieu; Peter Ngo; S Murthy Chennapragada; Dominic A Fitzgerald; Jonathan Karpelowsky; Chetan Pandit; Hiran Selvadurai; Paul D Robinson

doi:10.1016/j.prrv.2021.08.001

Update in management of paediatric primary spontaneous pneumothorax

Paediatr Respir Rev. 2022 Mar:41:73-79. doi: 10.1016/j.prrv.2021.08.001. Epub 2021 Aug 10.

Authors

Nathan Lieu¹, Peter Ngo², S Murthy Chennapragada³, Dominic A Fitzgerald¹, Jonathan Karpelowsky⁴, Chetan Pandit⁵, Hiran Selvadurai¹, Paul D Robinson⁶

Affiliations

¹ Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
² Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
³ Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of Interventional Radiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
⁴ Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
⁵ Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
⁶ Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia. Electronic address: paul.robinson1@health.nsw.gov.au.

PMID: 34511373
DOI: 10.1016/j.prrv.2021.08.001

Abstract

Paediatric spontaneous pneumothorax (PSP) management continues to lack paediatric-specific guideline recommendations. There have been increasing reports of paediatric retrospective case studies supplemented by important well designed RCT (predominantly) adult studies. Taken together, these suggest that conservative management may have an increasing role to play in the management of PSP and that aspiration may have limited utility as a first line intervention. Our local experience, as part of a multicentre retrospective analysis and subsequent audit of management since, corroborates recent published data: it highlights an increasing trend towards conservative management in spontaneous pneumothorax with similar rates of recurrence, compared to intervention, and low use of aspiration with similarly low success rates. We have therefore updated our local practice guidelines and share these with readers. Specifically, we have removed aspiration in the management of primary spontaneous pneumothorax and reserved intervention for children who are clinically unstable or show evidence of increasing air leak irrespective of pneumothorax size. Whilst the success of this change in clinical practice will need to be reviewed in the next 5-10 years, the overall low incidence of the condition, demands a multicentre, and probably multinational, collaborative approach to allow the best chance of obtaining definitive evidence to guide clinical paediatric management.

Keywords: Children; Conservative management; Operative intervention; Spontaneous pneumothorax.

Publication types

Review

MeSH terms

Adult
Child
Conservative Treatment / adverse effects
Humans
Pneumothorax* / surgery
Recurrence
Retrospective Studies