Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T06:07:42.451Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical descriptors of pneumothorax following chest tube removal in paediatric cardiac surgery

Published online by Cambridge University Press:  22 October 2020

Christine LaGrasta Open the ORCID record for Christine LaGrasta [Opens in a new window] ,
Mary McLellan  and
Jean Connor
Christine LaGrasta*
Affiliation:
Department of Nursing Patient Services, Heart Center, Boston Children’s Hospital, Boston, MA, USA
Mary McLellan
Affiliation:
Department of Nursing Patient Services, Heart Center, Boston Children’s Hospital, Boston, MA, USA
Jean Connor
Affiliation:
Department of Nursing Patient Services, Cardiovascular and Critical Care Services, Boston Children’s Hospital, Boston, MA, USA Department of Paediatrics, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: C. LaGrasta DNP, RN, CPNP-PC/AC, Heart Center, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Tel: +1 617 355 8083; Fax: +1 617 730-1034. E-mail: christine.lagrasta@childrens.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention.

Methods:

A single-institution retrospective descriptive study (1 January, 2010–31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old.

Results:

Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes.

Conclusions:

In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.

Keywords

Pneumothoraxcardiac surgerychest tubepaediatric
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 121 - 124
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Taylor, AC, Bates, KE, Kipps, A. Variability in paediatric cardiac potoperative chest tube management. Cardiol Young 2018; 28: 1471–1474.CrossRefGoogle Scholar
Pacharn, P, Heller, DND, Kammen, BF, et al. Are chest radiographs routinely necessary following thoracostomy tube removal? Pediatr Radiol 2002; 32: 138–142.10.1007/s00247-001-0591-5CrossRefGoogle ScholarPubMed
Van den Boom, J, Battin, M. Chest radiographs after removal of chest drains in neonates: clinical benefit or common practice? Arch Dis Child Fetal Neonatal Ed 2007; 92, F46–F48.Google ScholarPubMed
Woodward, CS, Dowling, D, Taylor, RP, Salvin, C. The routine use of chest radiographs after chest tube removal in children who have had cardiac surgery. J Pediatr Health Care 2013; 27: 189–194.10.1016/j.pedhc.2011.09.003CrossRefGoogle ScholarPubMed
Cohen, S, Liu, A, Gurvitz, M, et al. Exposure to low-dose ioninzing ration from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation 2018; 137: 1334–1345.Google Scholar
Hall, EJ. Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 2002; 32: 700–706.CrossRefGoogle ScholarPubMed
Johnson, JN, Hornik, CP, Li, JS, et al. Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 2014; 130: 161–167.10.1161/CIRCULATIONAHA.113.005425CrossRefGoogle ScholarPubMed