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VOLUME 20 , ISSUE 8 ( 2016 ) > List of Articles


Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

Ahmed El-Nawawy, Amina Al-Halawany, Manal Antonios, Reem Newegy

Keywords : Barotrauma, high-frequency oscillatory ventilation, mechanical ventilation, pediatrics, pneumothorax

Citation Information : El-Nawawy A, Al-Halawany A, Antonios M, Newegy R. Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit. Indian J Crit Care Med 2016; 20 (8):453-458.

DOI: 10.4103/0972-5229.188191

License: CC BY-ND 3.0

Published Online: 01-02-2014

Copyright Statement:  Copyright © 2016; The Author(s).


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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  1. Winnie GB. Pneumothorax. In: Kliegman RM, Behrman RE, Stanton BF, editors. Nelson Textbook of Paediatrics. 19 th ed. Philadelphia: Saunders Elsevier; 2011. p. 1835-7.
  2. Eckstein M, Henderson S, Markovchick V. Thorax. In: Marx JA, editor. Rosen`s Emergency Medicine: Concepts and Clinical Practice. 5 th ed. St. Louis: Mosby; 2002. p. 386-91.
  3. Strange C. Pleural complications in the intensive care unit. Clin Chest Med 1999;20:317-27.
  4. de Latorre FJ, Tomasa A, Klamburg J, Leon C, Soler M, Rius J. Incidence of pneumothorax and pneumomediastinum in patients with aspiration pneumonia requiring ventilatory support. Chest 1977;72:141-4.
  5. Rankine JJ, Thomas AN, Fluechter D. Diagnosis of pneumothorax in critically ill adults. Postgrad Med J 2000;76:399-404.
  6. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. JAMA 2002;287:345-55.
  7. de Lassence A, Timsit JF, Tafflet M, Azoulay E, Jamali S, Vincent F, et al. Pneumothorax in the intensive care unit: Incidence, risk factors, and outcome. Anesthesiology 2006;104:5-13.
  8. Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation. World J Crit Care Med 2014;3:8-14.
  9. Flater A, Shann F, Pearson G. PIM2: A revised version of the pediatric index of mortality. Intensive Care Med 2003;29:278-85.
  10. Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: Prospective, observational, multicentre study. Lancet 2003;362:192-7.
  11. Zhan C, Smith M, Stryer D. Accidental iatrogenic pneumothorax in hospitalized patients. Med Care 2006;44:182-6.
  12. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med 2010;17:11-7.
  13. Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: Correlation with chest radiography and CT - Initial experience. Radiology 2002;225:210-4.
  14. Johnson NN, Toledo A, Endom EE. Pneumothorax, pneumomediastinum, and pulmonary embolism. Pediatr Clin North Am 2010;57:1357-83.
  15. Yarmus L, Feller-Kopman D. Pneumothorax in the critically ill patient. Chest 2012;141:1098-105.
  16. Kumar A, Pontoppidan H, Falke KJ, Wilson RS, Laver MB. Pulmonary barotrauma during mechanical ventilation. Crit Care Med 1973;1:181-6.
  17. Lew TW, Kwek TK, Tai D, Earnest A, Loo S, Singh K, et al. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA 2003;290:374-80.
  18. Sassoon CS, Light RW, O′Hara VS, Moritz TE. Iatrogenic pneumothorax: Etiology and morbidity. Results of a Department of Veterans Affairs Cooperative study. Respiration 1992;59:215-20.
  19. Despars JA, Sassoon CS, Light RW. Significance of iatrogenic pneumothoraces. Chest 1994;105:1147-50.
  20. Cullen DJ, Caldera DL. The incidence of ventilator-induced pulmonary barotrauma in critically ill patients. Anesthesiology 1979;50:185-90.
  21. Gammon RB, Shin MS, Groves RH Jr., Hardin JM, Hsu C, Buchalter SE. Clinical risk factors for pulmonary barotrauma: A multivariate analysis. Am J Respir Crit Care Med 1995;152(4 Pt 1):1235-40.
  22. Weg JG, Anzueto A, Balk RA, Wiedemann HP, Pattishall EN, Schork MA, et al. The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:341-6.
  23. Brochard L, Roudot-Thoraval F, Roupie E, Delclaux C, Chastre J, Fernandez-Mondéjar E, et al. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 1998;158:1831-8.
  24. Petersen GW, Baier H. Incidence of pulmonary barotrauma in a medical ICU. Crit Care Med 1983;11:67-9.
  25. Woodring JH. Pulmonary interstitial emphysema in the adult respiratory distress syndrome. Crit Care Med 1985;13:786-91.
  26. Haake R, Schlichtig R, Ulstad DR, Henschen RR. Barotrauma. Pathophysiology, risk factors, and prevention. Chest 1987;91:608-13.
  27. Gattinoni L, Mascheroni D, Torresin A, Marcolin R, Fumagalli R, Vesconi S, et al. Morphological response to positive end expiratory pressure in acute respiratory failure. Computerized tomography study. Intensive Care Med 1986;12:137-42.
  28. Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M, Rossi F, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1988;69:824-32.
  29. Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, et al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 1994;271:1772-9.
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