Occult pneumothoraces in ventilated pediatric trauma patients: a review
Courtney Fulton1, Ioana Bratu1
1The Division of Pediatric General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta.
Insights
Occult pneumothoraces in severely injured, ventilated children are rare. This study found that these cases were successfully managed without chest tubes, suggesting observation is a safe approach.
Area of Science:
- Pediatric Trauma Care
- Thoracic Surgery
- Critical Care Medicine
Background:
- Clinical management of occult pneumothoraces in adults lacks consensus, with limited pediatric research.
- Severely injured, ventilated children with occult pneumothoraces require further outcome investigation.
Purpose of the Study:
- To investigate the outcomes of occult pneumothoraces in pediatric trauma patients requiring mechanical ventilation.
- To evaluate the safety and efficacy of non-invasive management strategies for occult pneumothoraces in this population.
Main Methods:
- Retrospective chart review of ventilated pediatric patients with Injury Severity Score > 12 and diagnosed occult pneumothorax via CT scan.
- Data sourced from the Alberta Trauma Registry between 2001 and 2011.
Main Results:
- Fifteen pediatric trauma patients (average age 13.4 years) presented with 19 occult pneumothoraces.
- All cases were successfully treated conservatively without the need for chest tube insertion.
- Patients required an average of 2.3 days on mechanical ventilation.
Conclusions:
- Occult pneumothoraces are infrequent in severely injured, ventilated pediatric trauma patients.
- Conservative management (observation) appears safe and effective for occult pneumothoraces in this cohort.
- Findings support existing evidence for non-invasive treatment of occult pneumothoraces under positive-pressure ventilation.
Background:
Currently there is no clinical consensus on how to treat occult pneumothoraces in adults, and even less research has been done in children. We sought to understand the outcomes of severely injured, ventilated children with occult pneumothoraces.
Methods:
Using the Alberta Trauma Registry, we retrospectively reviewed the charts of all ventilated pediatric patients at a children's hospital from 2001 to 2011 who had an injury severity score greater than 12 and a diagnosis of occult pneumothorax (seen on computed tomography scan but not on supine chest radiograph).
Results:
There were 1689 severely injured children, with 496 admitted to the pediatric intensive care unit (PICU) and ventilated. A total of 130 children were found to have pneumothoraces, and of those, 96 were admitted to the PICU. Of those, 15 children had a total of 19 occult pneumothoraces, and all were successfully treated without chest tubes. The average age was 13.4 (range 2.0-17.0) years, and 54% of these children were male. The average time spent on the ventilator was 2.3 (range 0-13) days, and 7 children had at least 1 operation.
Conclusion:
In our institution, occult pneumothoraces occur in very few severely injured, ventilated pediatric trauma patients. Our study adds to the increasing evidence in the adult and pediatric literature suggesting that occult pneumothoraces may be safely observed even while under positive-pressure ventilation.
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