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Management of pneumothorax in children
1Department of Pediatric Surgery, Ege University, Faculty of Medicine, Izmir, Turkey.
Insights
Tube thoracostomy at the sixth intercostal space is effective for treating pediatric pneumothorax. This method avoids complications associated with other insertion sites, ensuring successful drainage of air and fluid.
Area of Science:
- Pediatric Surgery
- Thoracic Medicine
- Medical Device Efficacy
Background:
- Tube thoracostomy is a common procedure for pediatric pneumothorax.
- The optimal insertion site for tube thoracostomy in children requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of tube thoracostomies inserted at the sixth intercostal space at the midaxillary line in children.
- To compare this insertion site with other potential locations for pediatric tube thoracostomy.
Main Methods:
- Retrospective study of 97 children (67 male, 30 female; mean age 6.5 years) with pneumothorax treated with tube thoracostomy.
- All thoracostomy tubes were placed in the sixth intercostal space at the midaxillary line.
Main Results:
- Pneumothorax occurred on the right in 51.5%, left in 39.1%, and bilaterally in 9.2% of cases.
- All 97 patients treated with tube thoracostomy at the sixth intercostal space experienced an uneventful postoperative course.
- No complications were observed in any of the patients.
Conclusions:
- The sixth intercostal space at the midaxillary line is a safe and effective site for tube thoracostomy in children, facilitating drainage of both air and fluid.
- Insertion at the second intercostal space should be avoided due to risks of subclavian vein injury and the frequent need for a secondary tube for fluid drainage.
Background:
The efficacy of tube thoracostomies inserted at the sixth intercostal space at midaxillary line was evaluated retrospectively in children.
Methods:
Ninety-seven children with pneumothorax, treated by tube thoracostomy were taken into the study. There were 67 male and 30 female patients with a mean age of 6.5 years (range 1 days to 15 years)
Results:
Pneumothorax was located at the right side in 50 (51.5%), and at the left in 38 (39.1%) of the cases. Bilateral pneumothorax was found in 9 additional patients (9.2%). All patients were treated with tube thoracostomy placed in the pleural cavity at the sixth intercostal space at the mid-axillary line. Postoperative course was uneventful and no complication was encountered at any of the patients.
Conclusions:
On the basis of these data we suggest that all thoracostomy tubes should be inserted on the sixth intercostal space where both air and the accumulating fluid can be reached. The insertion of the thoracostomy tube at the second intercostal space must be avoided since it carries a high risk of subclavian vein injury in small children, and also a secondary tube is frequently required to drain the accompanying intrapleural fluid.