Retrospective assessment of pediatric patients with tube thoracostomy inserted in a tertiary pediatric intensive care unit

Aims: The aim of this study was to examine the indications for tube thoracostomy (TT) procedures in pediatric intensive care units and to analyze the role of chest X-rays in the subsequent monitoring and management of patients. Methods: A retrospective evaluation of 31 pediatric patients aged 1 month to 18 years who had been admitted between January 2023 to July 2023 at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, were performed. Children who underwent TT were included. Demographic data, clinical variables, and outcome data were analyzed Results: The median age was 50 (4-214) months, and the gender distribution of the patients was almost equal. The median duration of a PICU stay was 10 (4-100) days. Pneumothorax (PTX) was diagnosed in 45,1%, pleural effusion in 38,7%, and hemothorax in 16,1% of patients. Six (19,4%) patients experienced complications related to chest tubes. Invasive mechanical ventilation (IMV) was required in 19 patients (61,3%), and the median duration of IMV was 9 (3-93) days. A total of 23 patients (74,2%) required non-invasive mechanical ventilation (NIMV) support during their stay in PICU. There was no statistically significant difference between indications of TT and length of stay, NIMV and IMV requirement, duration of TT, complications, and mortality. Conclusion: TT is a life-saving interventional procedure in emergencies. The absence of proper execution of this technique may result in considerable morbidity and fatality. Hence, all clinicians must possess a comprehensive understanding of the tube thoracostomy operation.

Keywords:

pediatrics, pleural effusion, pneumothorax trauma, thoracostomy,

PDF

___

Xing LY, Yin J, Shao M, et al. Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study. BMC Anesthesiol. 2018;18(1):169.
Vilkki VA, Gunn JM. Complications related to tube thoracostomy in Southwest Finland hospital district between 2004 and 2014. Scand J Surg. 2020;109(4):314-319.
Valk JW, Plötz FB, Schuerman FA, van Vught H, Kramer PP, Beek EJ. The value of routine chest radiographs in a paediatric intensive care unit: a prospective study. Pediatr Radiol. 2001;31(5):343-347.
Hafezi N, Cromeens BP, Morocho BS, Raymond JL, Landman MP. Thoracostomy tube removal in pediatric trauma: film or no film? J Surg Res. 2022;269:51-58.
Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60 Suppl 1(Suppl 1):i1-i21.
Çevik M, Çavuş UY, Büyükcam F, et al. Acil serviste göğüs travmalı çocuk hastaların geriye dönük incelenmesi. Kocatepe Tıp Derg. 2012;5(13):63-68.
Avcı A, Özçelik C. Çocuklarda toraks travmaları. In: Özyurtkan MO, Bostancı K, Özpolat B, eds. Toraks travması. Ankara Nobel Tıp Kitapevleri, Ankara. 2018:275-2780.
McBeth PB, Savage SA. Tube thoracostomy. Atlas Oral Maxillofac Surg Clin North Am. 2015;23(2):151-157.
Sartorelli KH, Vane DW. The diagnosis and management of children with blunt injury of the chest. Semin Pediat Surg. 2004;13(2):98-105.
Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994;29(1):33-38.
Papadakos PJ, Karcz M, Lachmann B. Mechanical ventilation in trauma. Curr Opin Anaesthesiol. 2010;23(2):228-232.
Chiumello D, Coppola S, Froio S, Gregoretti C, Consonni D. Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med. 2013;39(7):1171-1180.
Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-259
Essouri S, Carroll C; Pediatric Acute Lung Injury Consensus Conference Group. Noninvasive support and ventilation for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S102-S110.
Reed RC, Waters BL, Siebert JR. Complications of percutaneous thoracostomy in neonates and infants. J Perinatol. 2016;36(4):296-299.
Strutt J, Kharbanda A. Pediatric chest tubes and pigtails: an evidence-based approach to the management of pleural space diseases. Pediatr Emerg Med Pract. 2015;12(11):1-21.
Martin K, Emil S, Zavalkoff S, et al. Transitioning from stiff chest tubes to soft pleural catheters: prospective assessment of a practice change. Eur J Pediatr Surg. 2013;23(5):389-393.
Lim KE, Tai SC, Chan CY, et al. Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph? Clin Imaging. 2005;29(6):401-405.
McGrath E, Ranstrom L, Lajoie D, McGlynn L, Mooney D. Is a chest radiograph required after removal of chest tubes in children?. J Pediatr Health Care. 2017;31(5):588-593.