Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit
Ahmed Ahmed El-Nawawy1, Amina Sedky Al-Halawany1, Manal Abdelmalik Antonios1
1Pediatric Department, Pediatric Intensive Care Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Pneumothorax is common in Pediatric Intensive Care Units, particularly in mechanically ventilated patients. Implementing lung-protective strategies is crucial to reduce its occurrence and improve patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonary Medicine
- Medical Device Safety
Background:
- Pneumothorax is a critical condition requiring immediate attention.
- Understanding its incidence and causes in the Pediatric Intensive Care Unit (PICU) is vital for improving patient care.
- Iatrogenic pneumothorax (IP) is a significant concern in critically ill children.
Purpose of the Study:
- To determine the incidence and characteristics of pneumothorax in PICU patients.
- To identify risk factors and common causes of pneumothorax in this population.
- To evaluate the impact of pneumothorax on patient outcomes, including mortality and length of stay.
Main Methods:
- A retrospective review of 1298 patient case notes from a PICU over a 5-year period.
- Comparison of patients who developed pneumothorax with those who did not.
- Diagnosis primarily relied on chest X-ray and clinical examination.
Main Results:
- Pneumothorax occurred in 10.4% of PICU patients (135 cases).
- Patients with pneumothorax had higher mortality, longer hospital stays, and increased need for mechanical ventilation (MV).
- Iatrogenic pneumothorax (95%) was mainly caused by MV-related barotrauma and central venous catheter insertion.
Conclusions:
- Pneumothorax is a frequent complication in PICU patients, especially those requiring MV.
- The study highlights the importance of strict adherence to lung-protective ventilation strategies.
- Minimizing iatrogenic pneumothorax can improve outcomes for critically ill children.
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.
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