Management of spontaneous pneumothorax in children and adolescents

VATS: video-assisted thoracoscopic surgery.
* A patient is unstable if he or she has significant dyspnea, hypoxemia, or severe pain; such patients are typically unable to speak in whole sentences.
¶ We suggest supplemental oxygen therapy for most hospitalized patients with primary spontaneous pneumothorax since this may enhance reabsorption. Because of limited evidence for benefit and concerns for oxygen toxicity, we avoid its use in neonates (except as needed to maintain oxygenation) and typically limit duration of oxygen therapy to <48 (or <72) hours for other patients.
Δ A pneumothorax is typically considered large if it occupies >30% of the hemithorax. In adolescents or adults, this corresponds to approximately ≥3 cm of air between the pleural line and apical chest wall, or ≥2 cm between the entire lateral lung edge and the chest wall on an upright chest radiograph.
◊ For patients managed conservatively, criteria have not been developed to guide how long to observe and how long to wait before intervention if the pneumothorax persists. However, we would generally place a thoracostomy tube within 24 to 48 hours if the pneumothorax is not improving and earlier if it is increasing in size.
§ Patients who have recovered from pneumothorax should be counseled to return for any new symptoms. They should be counseled against smoking and avoid flying in unpressurized aircraft. Travel in commercial, pressurized aircraft is reasonable after 1 week. The risk of recurrence is approximately 30%. Most recurrences are within 1 year.