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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: [email protected]
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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
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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