Primary Versus Delayed Surgical Therapy for Pediatric Spontaneous Pneumothorax
Pneumothorax
About this trial
This is an interventional treatment trial for Pneumothorax focused on measuring Spontaneous Pneumothorax, Video Assisted Thoracoscopic Surgery, Tube Thoracostomy, Pediatric Surgery
Eligibility Criteria
Inclusion Criteria:
- Children ages 5 to 18 with clinical diagnosis of primary spontaneous pneumothorax (symptoms of chest pain and/or shortness of breath and pneumothorax demonstrated on chest radiograph) and no prior history of pneumothorax
Exclusion Criteria:
- Blunt or penetrating trauma
- Cystic fibrosis
- Pneumonia
- Uncontrolled asthma with hospitalization for exacerbation within previous 30 days
- Congenital cystic adenomatoid malformation or congenital lobar emphysema
- History of previous cardiac or pulmonary surgery
Sites / Locations
- Texas Children's Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Primary Surgery Group
Initial Non-operative management
Patients randomized to the primary surgical intervention group will undergo VATS (video-assisted thoracoscopic surgery), apical blebectomy and mechanical pleurodesis during the initial hospital admission by the admitting staff surgeon. The general principles of the surgical technique consist of a 3-port thoracoscopic approach, stapled blebectomy, apical mechanical pleurodesis, and placement of chest tube . Variations of this technique will be at the discretion of the surgeon.
Those randomized to the control group will be admitted and their chest tube or percutaneous drainage catheter managed according to standard protocol. This consists of a minimum of 48 hours of Pleur-Evac suction and daily chest radiographs. The drainage tube is then placed to water seal when resolution of the pneumothorax is documented by x-ray, as well as absence of an air leak. If there are no clinical or radiographic changes after a water seal period, the chest tube is then removed. A post-removal chest radiograph is obtained and the patient is discharged if clinical and radiographic criteria are met.