What is it?A pneumothorax is an accumulation of air in the pleural space (the space outside the lung, but inside the chest). As air accumulates in this space, it assumes a higher pressure than the lung and causes the lung to collapse.
Spontaneous pneumothorax usually occurs in teenagers or young adults who are tall and thin. A small percentage also have disorders of connective tissue which make the lungs prone to developing cysts (blebs, bullae) that can “pop” or rupture into the pleural space.
A pneumothorax can also be caused by trauma to the surface of the lung from a rib fracture, a penetrating injury to the chest wall, or a needle during placement of a central line.
What will be the treatment?Most of the time a pneumothorax can be managed with a small thin tube placed through the skin and subcutaneous soft tissue into the pleural space. This tube is placed to suction, allowing the air around the lung to be sucked out and the lung to re-expand. While the chest tube is in place, your child’s doctors will obtain a daily chest x-ray to make certain that the lung has remained adequately expanded. Every day they will also come into the room, several times, and ask your child to breathe deeply and cough. During this time, they will be looking at a small chamber on the box into which the chest tube drains. They are looking for bubbling of air into one of the chambers on this collection device which signifies that there is still a leak of air out of the lung into the pleural space. Over a course of hours to days, the lung seals off the hole in the pleura. When the hole is sealed, the chest tube may be removed.
Although most cases of pneumothorax can be managed with a placement of a chest tube without the need for operative intervention, persistent or recurrent pneumothorax may need to be managed with video assisted thoracoscopic surgery (VATS). The purpose of this operation is two-fold: 1) to resect any areas of lung that appear to have a large cyst (bleb) that may be the cause of the air leak; 2) to create an abrasion on the inside of the chest wall that makes it “stickier” so that the expanded lung becomes inseparable from this wall (this process is known as mechanical pleurodesis).
The actual VATS procedure involves making 2-3 small incisions (1/5 inch) on the chest and inserting a thing tube with a camera attached.
Compared to a large chest incision, VATS allows for a shorter length in hospital stay, a quicker recovery and less pain.
What will happen in the hospital?Your child will have a chest tube in place, post operatively. This helps to drain any excess fluid and permits the expanded lung to stick to the chest wall. A chest x-ray will be obtained to confirm tube placement.
Pain will be well controlled with either around the clock pain medication or use of a patient controlled analgesic (PCA).
While in the hospital, the staff will be monitoring your child’s oxygen levels. There are certain occasions when supplemental oxygen may need to be administered.
Your child will be allowed to have a regular diet.
It is important for your child to use the incentive spirometer that will be supplied. This allows your child to take deep breaths and also helps to prevent a pneumonia from developing. It is important to use this several times an hour, while awake.
It is also important for your child to ambulate very shortly after the operation because ambulation improves lung aeration.
When will my child be discharged?
- Your child will be discharged once the chest tube has been removed, his/her pain is well controlled, and he/she no longer requires supplemental oxygen.
- The dressing covering the chest tube site will be covered with gauze and a plastic dressing. It is important to leave this in place for 24-48 hours before removing.
What will be my child's recovery?
- Once discharged, we recommend your child refrain from activities, gym or competitive sports for at least 2 weeks.
- We recommend refraining from any contract sports for 6 months (a sudden blow to the chest may cause a pneumothorax).
- Your child will be able to take a shower, but cannot take a bath for 7-10 days.
- Your child may require a day or two of pain medication, as needed. Since the success of the operation depends partially on the inflammatory adhesions formed between the lung and chest wall, we do not recommend the use of anti-inflammatory medications (ibuprofen, acetaminophen, ketorolac) but instead recommend low dose narcotics.
- Air travel and scuba diving should be avoided for 6 months following the procedure. Please speak to your doctor if plane flight is necessary during the initial 6 months of recovery.
What should I be looking out for after the surgery/hospitalization?
- There will be little white bandages in place, over the surgical sites. These will fall off, on their own, in approximately 7-10 days.
- You should call the pediatric surgery department if your child develops a fever, has problems breathing, complains of chest pain or shortness of breath, has redness, swelling or drainage around the surgical incisions or has pain that is not well controlled.