Kagan Shelly, Nahum Elhanan, Kaplan Eytan, Kadmon Gili, Gendler Yulia, Weissbach Avichai
Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Pulmonol. 2021 Aug;56(8):2729-2735. doi: 10.1002/ppul.25509. Epub 2021 May 28.
Persistent air leak (PAL) complicates various lung pathologies in children. The clinical characteristics and outcomes of children hospitalized in the pediatric intensive care unit (PICU) with PAL are not well described. We aimed to elucidate the course of disease among PICU hospitalized children with PAL.
A retrospective cohort study of all PICU-admitted children aged 0-18 years diagnosed with pneumothorax complicated by PAL, between January 2005 and February 2020 was conducted at a tertiary center. PAL was defined as a continuous air leak of more than 48 h.
PAL complicated the course of 4.8% (38/788) of children hospitalized in the PICU with pneumothorax. Two were excluded due to missing data. Of 36 children included, PAL was secondary to bacterial pneumonia in 56%, acute respiratory distress syndrome (ARDS) in 31%, lung surgery in 11%, and spontaneous pneumothorax in 3%. Compared to non-ARDS causes, children with ARDS required more drains (median, range: 4, 3-11 vs. 2, 1-7; p < .001) and mechanical ventilation (100% vs. 12%; p < .001), and had a higher mortality (64% vs. 0%; p < .001). All children with bacterial pneumonia survived to discharge, with a median air leak duration of 14 days (range 3-72 days). Most of which (90%) were managed conservatively, by continuous chest drainage.
Bacterial pneumonia was the leading cause of PAL in this cohort. PAL secondary to ARDS was associated with a worse outcome. In contrast, non-ARDS PAL was successfully managed conservatively, in most cases.
持续性气胸（PAL）使儿童的各种肺部疾病复杂化。儿科重症监护病房（PICU）中因PAL住院的儿童的临床特征和预后尚未得到充分描述。我们旨在阐明PICU中因PAL住院的儿童的疾病进程。
在一家三级中心对2005年1月至2020年2月期间所有0至18岁因气胸并发PAL而入住PICU的儿童进行了一项回顾性队列研究。PAL定义为持续漏气超过48小时。
在PICU因气胸住院的儿童中，4.8%（38/788）的病程并发PAL。两名儿童因数据缺失被排除。在纳入的36名儿童中，56%的PAL继发于细菌性肺炎，31%继发于急性呼吸窘迫综合征（ARDS），11%继发于肺部手术，3%继发于自发性气胸。与非ARDS病因相比，ARDS患儿需要更多的引流管（中位数，范围：4，3 - 11对2，1 - 7；p <.001）和机械通气（100%对12%；p <.001），且死亡率更高（64%对0%；p <.001）。所有细菌性肺炎患儿均存活至出院，漏气持续时间中位数为14天（范围3 - 72天）。其中大多数（90%）通过持续胸腔引流进行保守治疗。
细菌性肺炎是该队列中PAL的主要原因。ARDS继发的PAL预后较差。相比之下，在大多数情况下，非ARDS PAL通过保守治疗成功治愈。
