1 - Serviço de Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Apresentação oral no XVI Congresso SPCMIN Évora
Primary spontaneous pneumothorax (PSP) is the accumulation of air in the pleural space that is not triggered by any trauma or invasive procedure, mechanical ventilation, or pulmonary infection. PSP prevalence is estimated between 16-52 cases per 100,000 people, with most cases noted before the age of 23 years, and more particularly in tall and fine male adolescents around 16 years. Diagnosis of PSP is usually evident, but the best management to adopt is clearly not consensual. Procedures regarding early diagnosis, chest CT-scan indication, therapy, and PSP recurrence prevention are highly variable and center dependent, particularly in pediatric patients. In adults, guidelines specify the place of radiological examinations and the therapeutic strategy, but their application to pediatric patients is not well characterized.
We present the data of a Pediatric surgery team in a tertiary care center for the past 10 years in the management of PSP. The aim of this 10-year retrospective study is to review the standard of care in our institution, and the most recent literature, proposing an evidence and experience based protocol for the management of PSP in children, since there is no standardized approach to PSP in the pediatric population.
At our institution, the action protocol always starts with conservative measures, being increasingly more invasive according to patient evolution. The standard of practice at our center consists of evaluating the stability of the patient and choosing an initial approach depending on patient status and radiology evidence: a stable patient with a small pneumothorax is generally treated in a conservative manner (monitoring, facial mask with high flow O2), whilst the unstable patient and/or with a large pneumothorax is submitted to a thoracic drainage. Surgical approach (thoracoscopic atypical pulmonary resection of the bleb site) is offered to patients with non-resolution of the pneumothorax or to patients with recurrent disease.
In conclusion, PSP should have a standardized approach in children, always considering a minimally invasive surgical approach for a faster definitive resolution of the disease.
Palavras Chave: Pneumotorax espontâneo primário, pediatria, toracoscopia