Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

Abstract

Objective:Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention.Aims:The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period.Settings and Design:Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not. The most common tool for diagnosis used was chest X-ray followed by a clinical examination.Subjects and Methods:Case notes of 1298 patients admitted in PICU over 1-year study.Results:Patients with pneumothorax had higher mortality rate (P < 0.001), longer length of stay (P < 0.001), higher need for mechanical ventilation (MV) (P < 0.001), and were of younger age (P < 0.001), lower body weight (P < 0.001), higher pediatric index of mortality 2 score on admission (P < 0.001), higher pediatric logistic organ dysfunction score (P < 0.001), compared to their counterpart. Iatrogenic pneumothorax (IP) represented 95% of episodes of pneumothorax. The most common causes of IP were barotrauma secondary to MV, central vein catheter insertion, and other (69.6%, 13.2%, and 17.2%, respectively). Compared to ventilated patients without pneumothorax, ventilated patients who developed pneumothorax had a longer duration of MV care (P < 0.001) and higher nonconventional and high-frequency oscillatory ventilation settings (P < 0.001).Conclusions:This study demonstrated that pneumothorax is common in Alexandria University PICU patients, especially in those on MV and emphasized the importance of the strict application of protective lung strategies among ventilated patients to minimize the risk of pneumothorax.

Factors Affecting Development of Pneumothorax in Critically Ill Children: A 3-Year Study

“…Therefore, it is not appropriate to compare these studies with results of the current study. In contrast to these data a study from India reported a 10.4% prevalence rate of pneumothorax in PICU patients (21), which was very high compared to reported rate of 4.4% in the current study.…”

“…In a study reported by Silva and colleagues; duration of MV, PICU and hospital stays were similar between both groups (18). In a study evaluating 1238 pediatric patients admitted to PICU, those with pneumothorax had higher mortality rate (P < 0.001), and longer duration of hospitalization (P < 0.001) (21). Similar to our study ventilated patients who developed pneumothorax had a longer duration of mechanical ventilation compared with ventilated patients without pneumothorax (P < 0.001) (21).…”

“…Pneumothorax was observed in average on 11.6th day of mechanical ventilation. In a recent pediatric study, pneumothorax developed on 6.5th day when the diagnosis was respiratory diseases, and on 8th day when there was a non-respiratory etiology (21). In a study reported by Silva and colleagues; duration of MV, PICU and hospital stays were similar between both groups (18).…”

“…In a study evaluating 1238 pediatric patients admitted to PICU, those with pneumothorax had higher mortality rate (P < 0.001), and longer duration of hospitalization (P < 0.001) (21). Similar to our study ventilated patients who developed pneumothorax had a longer duration of mechanical ventilation compared with ventilated patients without pneumothorax (P < 0.001) (21). This study also reported significantly higher than expected mortality rate in patients with pneumothorax (18) which is very similar to our results.…”

Evaluation of Patients with Spontaneous Pneumothorax Secondary to Viral Pneumonia in Pediatric Intensive Care in 2018

“…While five patients underwent tube thoracostomy, all patients received oxygen therapy with 100% FiO 2 until pneumothorax ameliorated. In a study, it has been established that length of intensive care unit stay and mortality increased in patients developing pneumothorax out of 1238 pediatric patients admitted to the intensive care unit (22). Although it was seen that length of intensive care unit stay of the cases with SP secondary to viral pneumonia was longer than that of pneumonia cases who did not develop pneumothorax in our center, a comparison could not be made because of the small sample size.…”