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Persistent pulmonary air leak in the pediatric intensive care unit: Characteristics and outcomes

Shelly Kagan1,2, Elhanan Nahum2,3, Eytan Kaplan2,3

  • 1Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.

Pediatric Pulmonology
|May 28, 2021
PubMed

Insights

Persistent air leak (PAL) in children admitted to the pediatric intensive care unit (PICU) is often caused by bacterial pneumonia and typically managed conservatively. However, PAL secondary to acute respiratory distress syndrome (ARDS) is linked to worse outcomes and higher mortality.

Area of Science:

  • Pediatric critical care medicine
  • Thoracic surgery
  • Pulmonology

Background:

  • Persistent air leak (PAL) is a significant complication in pediatric lung diseases.
  • Clinical data on children with PAL in the pediatric intensive care unit (PICU) are limited.
  • Understanding PAL's characteristics and outcomes in critically ill children is crucial.

Purpose of the Study:

  • To describe the clinical features and outcomes of children with PAL admitted to the PICU.
  • To identify the primary causes of PAL in this pediatric population.
  • To compare outcomes based on the underlying cause of PAL.

Main Methods:

  • Retrospective cohort study of children (0-18 years) with pneumothorax and PAL in a tertiary PICU (2005-2020).
  • PAL defined as continuous air leak >48 hours.
  • Data collected on demographics, underlying conditions, interventions, and mortality.

Main Results:

  • PAL occurred in 4.8% of PICU pneumothorax cases (36 children analyzed).
  • Bacterial pneumonia (56%) was the leading cause, followed by ARDS (31%).
  • ARDS-related PAL showed higher drain usage, mechanical ventilation (100%), and mortality (64%) compared to non-ARDS causes (0% mortality).
  • Bacterial pneumonia cases had a median air leak of 14 days and were mostly managed conservatively (90%).

Conclusions:

  • Bacterial pneumonia is the most common cause of PAL in critically ill children.
  • PAL associated with ARDS has a poorer prognosis.
  • Non-ARDS PAL can often be managed successfully with conservative measures like chest drainage.
Abstract

Keywords:
Broncho pleural fistulaalveolopleural fistulapediatric intensive care unitpersistent air leak

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