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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTAwMzU1Mi10cmVhdG1lbnQ=\nDrugs & Diseases > Pediatrics: General Medicine\nPediatric Pneumothorax Treatment & Management\nAuthor: Andres Carrion, MD, FAAP; Chief Editor: Girish D Sharma, MD, FCCP, FAAP more...\nPediatric Pneumothorax\nSections Pediatric Pneumothorax\nChest Radiography\nOther Imaging Studies\nTreatment for spontaneous pneumothorax in children varies based on the size of the pneumothorax, severity of respiratory distress, and presence of underlying lung disease. Many cases of spontaneous pneumothorax resolve with conservative therapies. Individuals with small pneumothoraces who are asymptomatic can be observed and do not necessarily require intervention. Pneumothorax should resolve within 12 days. Although subcutaneous emphysema can be extensive, it does not create an increased risk of local infections. Management of subcutaneous emphysema should be focused on symptoms. [3, 6]\nAdministering 100% oxygen via a nonrebreathing face mask hastens the absorption of loculated gas. High concentrations of supplemental oxygen create a partial-pressure gradient between the pleural cavity and end-capillary blood by decreasing the partial-pressure contribution of nitrogen (nitrogen washout), increasing reabsorption of gas from the pleural cavity. [2] This treatment should not be continued for long periods. The patient should be observed and chest radiography should be repeated to look for improvement. For secondary spontaneous pneumothorax, underlying disease should be treated.\nLarge (occupying >30% of the hemithorax) or complicated pneumothorax requires hospitalization and direct mechanical evacuation of pleural air. Clinically stable patients with a primary spontaneous pneumothorax can be treated with needle aspiration. Clinically unstable patients and most patients with underlying lung disease (secondary spontaneous pneumothorax) should be treated with chest tube insertion. A patient with a traumatic pneumothorax is best treated with a chest tube, because the condition may rapidly convert into a tension pneumothorax, especially if positive-pressure ventilation is applied. A tension pneumothorax requires immediate decompression with needle thoracostomy, followed by tube thoracostomy. [1]\nIn certain conditions with recurrent pneumothorax (such as cystic fibrosis), identification of an apical bleb sometimes requires thoracoscopic resection, and if no bleb is found, then either thoracoscopic or sclerosing pleurodesis is indicated.\nSee the image below.\nPneumothorax chest tube.\nThere is no general consensus on the best setting to monitor pediatric patients with small pneumothoraces; however, a cautious approach in these patients is usually appropriate. Clinically stable patients with small, primary spontaneous pneumothoraces can be initially observed in the hospital with administration of 100% supplemental oxygen via a nonrebreathing facemask. If the pneumothorax is small and is resolving within 12 hours, patients can generally be observed in an outpatient setting. Younger children may require longer observation in a hospital setting.\nOther supportive care, including pain medications, should be provided as needed to all patients with pneumothorax.\nPatients should have close outpatient follow-up and should also be given specific instructions to seek further medical care should they develop any new or worsening dyspnea or other respiratory symptoms.\nEvacuation of the pleural space is recommended for a large pneumothorax or in patients with significant pain, dyspnea, or hypoxemia. Pneumothorax in adults is generally considered to be large if there is 3 or more centimeters of air between the pleural line and the apical chest wall; however, it is difficult to determine the size of a pneumothorax in a pediatric patient as the thoracic size differs based on age and the size of the patient.\nOnly pleurodesis (intrapleural instillation of a sclerosing agent such as talc, fibrin glue, and antibiotics), video-assisted thoracoscopic surgery (VATS), and thoracotomy reduce the risk of future recurrence. Pleurodesis may be indicated for the first episode of a secondary pneumothorax owing to the high incidence of recurrence or after a recurrence of a primary pneumothorax.\nNeedle decompression is appropriate for clinically stable patients with large primary spontaneous pneumothoraces. In needle aspiration, air is manually withdrawn using an intravenous catheter connected to a syringe and three-way stopcock. Follow-up chest radiography should be performed approximately 4 hours after the procedure, and catheter can be removed at that time if adequate lung expansion has occurred. A persistent air leak is likely present if a substantial volume of air can be continuously withdrawn during needle aspiration. Air can also reaccumulate as a result of a persistent air leak after needle decompression; therefore, serial chest radiographs are important during close follow-up. Patients with reaccumulation of air require thoracostomy tube placement.\nThoracostomy (chest) tube is required in patients in whom needle aspiration fails as a result of a persistent air leak, patients with recurrent spontaneous pneumothorax, and some patients with secondary spontaneous pneumothorax. Pleurodesis can be performed at the time of thoracostomy tube placement to help decrease risk of recurrence of pneumothorax.\nVATS with pleurodesis is generally indicated in patients with primary spontaneous pneumothorax and persistent air leak that fails to improve with thoracostomy tube. VATS is also considered in recurrent primary or secondary spontaneous pneumothorax, but it should be considered on a case-by-case basis. [7, 10, 11]\nComplications directly related chest tube insertion may result in significant bleeding, infection, or both. Other complications of thoracostomy include pain and injury to thoracic neurovascular structures. Insertion too far below the recommended fourth or fifth intercostal space may result in intra-abdominal placement, with possible abdominal visceral or diaphragmatic injury.\nTension pneumothorax is a rare but serious potential complication of either primary or secondary spontaneous pneumothorax.\nAlso see Presentation/Complications.\nThe following consultations may be needed:\nInterventional radiologist\nTo decrease the risk of recurrence, children should avoid scuba diving. Additionally, on a temporary basis, 4 weeks after resolution of pneumothorax, all air travel, contact sports, and playing bass or woodwind musical instruments is to be avoided. [3]\nIt is strongly encouraged to avoid smoking exposure, and efforts should be directed at smoking cessation after the development of a pneumothorax.\nThere is a high rate of pneumothorax recurrence after a VATS procedure or chest tube drainage. Close follow-up is recommended.\nMacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug. 65 Suppl 2:ii18-31. [Medline].\nChoi WI. Pneumothorax. Tuberc Respir Dis (Seoul). 2014 Mar. 76 (3):99-104. [Medline].\nAmerican Academy of Pediatrics. Pneumothorax. Stokes DC, Dozor AJ. Pediatric Pulmonology, Asthma, and Sleep Medicine: A quick reference guide. 1st ed. Itasca, IL: American Academy of Pediatrics; 2018. 511-516.\nFlume PA. Pulmonary complications of cystic fibrosis. Respir Care. 2009 May. 54 (5):618-27. [Medline].\nRobinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev. 2009 Sep. 10 (3):110-7; quiz 117. [Medline].\nLopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?. Am J Surg. 2014 Oct. 208 (4):571-6. [Medline].\nSahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000 Mar 23. 342 (12):868-74. [Medline].\nAl Tawil K, Abu-Ekteish FM, Tamimi O, Al Hathal MM, Al Hathlol K, Abu Laimun B. Symptomatic spontaneous pneumothorax in term newborn infants. Pediatr Pulmonol. 2004 May. 37 (5):443-6. [Medline].\nSeguier-Lipszyc E, Elizur A, Klin B, Vaiman M, Lotan G. Management of primary spontaneous pneumothorax in children. Clin Pediatr (Phila). 2011 Sep. 50 (9):797-802. [Medline].\nDotson K, Johnson LH. Pediatric spontaneous pneumothorax. Pediatr Emerg Care. 2012 Jul. 28 (7):715-20; quiz 721-3. [Medline].\nBaumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001 Feb. 119 (2):590-602. [Medline].\nSoccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int. 2015 Dec. 31 (12):1139-44. [Medline].\nPneumothorax; left side.\nTension pneumothorax in an infant.\nPneumomediastinum.\nTension pneumothorax.\nAndres Carrion, MD, FAAP Clinical Assistant Professor of Pediatrics, Louisiana State University School of Medicine in New Orleans; Pediatric Pulmonologist, Our Lady of the Lake Children's Health; Board Review Director and Faculty, Pediatric Residency Program, Our Lady of the Lake Regional Medical Center; Staff Physician, Our Lady of the Lake Physician Group; Consulting Physician, Woman’s Hospital of Baton Rouge\nAndres Carrion, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society\nMegan E Collins, MD, MPH Resident Physician, Department of Pediatrics, Our Lady of the Lake Regional Medical Center\nMegan E Collins, MD, MPH is a member of the following medical societies: American Academy of Pediatrics\nMary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference\nGirish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center\nGirish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland\nRene J Forti, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore\nRene J Forti, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics\nThomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School\nThomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research\nWilliam Gluckman, DO, MBA, FACEP President and CEO, FastER Urgent Care\nWilliam Gluckman, DO, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Association for Physician Leadership\nHeidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center\nHeidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine\nencoded search term (Pediatric Pneumothorax) and Pediatric Pneumothorax\nBarotrauma and Mechanical Ventilation\nPulmonary Interstitial Emphysema\nBedside Ultrasonography for Pneumothorax\nPneumatocele\nAnterior Vertebral Body Growth-Modulation Tethering in Idiopathic Scoliosis\nLife After COVID-19: The Road to Recovery\n11 Abdominal Emergencies in Infants\nAccording to Pediatricians\nReport May Inform First Dietary Guidelines for Americans From Birth to 24 Months\nNeonatal Resuscitation Clinical Practice Guidelines (AHA, 2020)\nKindergartner in Texas Reportedly Dies From COVID-19\nA Teenager With Fever Who Can’t Talk After Visiting Mexico\nWhen Should Students Resume Sports After a COVID-19 Diagnosis?\nDiseases & Conditions Pediatric Pneumothorax\n2003 /viewarticle/494960 Conference Coverage\nRespiratory Disease in the Neonate: What Are the Best Approaches? 1 CE Credits Conference Coverage\n1 CE\nRespiratory Disease in the Neonate: What Are the Best Approaches?\nPerioperative Point-of-Care Ultrasound--Do You Know Best Practices?"