Factors affecting development of pneumothorax in critically ill children: A 3-year study


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Yazici M. U. , Sahin S., Ayar G., Azili M. N. , Koksal T., BAYRAKCİ B.

Iranian Journal of Pediatrics, vol.29, no.2, 2019 (Journal Indexed in SCI Expanded) identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 2
  • Publication Date: 2019
  • Doi Number: 10.5812/ijp.85816
  • Title of Journal : Iranian Journal of Pediatrics
  • Keywords: Albumin, Critically Ill Children, Mechanical Ventilation, Pediatric Intensive Care Unit, Pneumothorax

Abstract

© 2019, Author(s).Background: To determine the factors affecting the development of pneumothorax in critically ill children admitted to pediatric intensive care unit (PICU). Methods: This was a single-centered retrospective case control study comparing the clinical features of mechanically ventilated patients, who developed pneumothorax with matched control cases. Results: The study screened 2850 patients admitted to the PICU over a 3 year period. Among 1140 patients who were mechanically ventilated, 4.4% (n = 50) developed pneumothorax. Median age was 24 months. Patients with pneumothorax were found to have median pediatric risk of mortality (PRISM):26, Pediatric logistic organ dysfunction (PELOD):22 and multiorgan disfuction (MODS):3 whereas in the control group they were 15.5, 12, and 3, respectively. PRISM and PELOD were significantly higher in pneumothorax group. Pneumothorax was observed on the 11.6th day of mechanical ventilation (MV). Pneumothorax was mainly secondary to pneumonia (n = 18, 36%) and MV-related reasons (n = 13, 26%). The risk of pneumothorax was higher when P-mean was > 14 cmH2O and tidal volume (TV) was > 10 mL/kg (P < 0.05). The mean albumin level was 2.7 g/dL in the pneumothorax group compared with 3.6 g/dL in the control group (P < 0.001). The number of days on mechanical ventilator and the duration of hospital stay were statistically significant in pneumothorax group (P < 0.05). The mortality outcome was 44% (n = 22) in the pneumothorax group compared with 6.7% (n = 2) in the control group (P < 0.001). Conclusions: Pneumothorax in critically ill children was related to increased morbidity, mortality and prolonged length of stay in hospital. Higher pediatric risk of mortality (PRISM) and Pediatric logistic organ dysfunction (PELOD) scores were associated with increased risk of pneumothorax. Hypoalbuminemia as a reflection of malnutrition status of patients might be a risk factor.