Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study
| Autor: | Riyad Karmy-Jones, Scott R. Petersen, David M. Notrica, Herb A. Phelan, Thomas B. Coopwood, Brandon R. Bruns, Forrest O. Moore, Lawrence Lottenberg, Jenessa Hill, Vishal Bansal, Pamela W. Goslar, Marc DeMoya, Carlos V.R. Brown, Karl Pembaur, Raul Coimbra, John P. Sherck, George C. Velmahos, Lily R Stevens, Marc R. Matthews, Scott H. Norwood, Fausto Y. Vinces, Stephen L. Barnes, James M. Haan, Charles K C Hu, William S. Hoff, Pamela Garcia-Filion, Kelli H. Foulkrod |
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| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Adolescent Rib Fractures Radiography medicine.medical_treatment Thoracostomy Wounds Nonpenetrating Positive-Pressure Respiration medicine Humans Child Watchful Waiting Respiratory distress business.industry Infant Newborn Infant Pneumothorax General Medicine medicine.disease Occult Surgery Treatment Outcome Blunt trauma Child Preschool Pediatrics Perinatology and Child Health Radiology business Tomography X-Ray Computed Watchful waiting Pediatric trauma |
| Zdroj: | Journal of pediatric surgery. 47(3) |
| ISSN: | 1531-5037 |
| Popis: | Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined.A pediatric subgroup analysis (age18 years) from a multicenter, observational study evaluating OPTX management. Data analyzed were pneumothorax size, management outcome, and associated risk factors to characterize those that may be safely observed.Fifty-two OPTX (7.3 ± 6.2 mm) in 51 patients were identified. None were greater than 27 mm; all those under 16.5 mm (n = 48) were successfully managed without intervention. Two patients underwent initial tube thoracostomy (one [21 mm] and the other with bilateral OPTX [24 mm, 27 mm]). Among patients under observation (n = 49), OPTX size progressed in 2; one (6.4mm) required no treatment, while one (16.5 mm) received elective intervention. Respiratory distress occurred in one patient (10.7 mm) who did not require tube thoracostomy. Nine received positive pressure ventilation; 8 did not have a tube thoracostomy. Twenty-four patients (51%) had one or more rib fractures; 3 required tube thoracostomy.No pediatric OPTX initially observed developed a tension pneumothorax or adverse event related to observation. Pediatric patients with OPTX less than 16 mm may be safely observed. Neither the presence of rib fractures nor need for PPV alone necessitates intervention. |
| Databáze: | OpenAIRE |
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