Iatrogenic pneumothorax in pediatric practice: a preventable complication

Abstract

Iatrogenic pneumothorax is an uncommon but potentially life- threatening complication in paediatric practice. Children are particularly vulnerable due to anatomical and physiological differences We report two cases of iatrogenic tension pneumothorax in children following airway and neurosurgical procedures. A one year 2-month-old male child was admitted with complaints of prolonged fever was diagnosed with third ventricle space occupying lesion causing obstructive hydrocephalus. Following craniotomy, he developed sudden desaturations and subcutaneous emphysema. Bilateral tension pneumothorax was confirmed and managed with bilateral intercostal drain (ICD) insertion. A term 37 week born with birth weight 1.7 kilograms small for gestation baby with congenital stridor and respiratory distress a diagnostic laryngoscopy was done. Intraoperative during tracheostomy the baby developed desaturations and tachycardia. Immediate ICD insertion resulted in stabilization. Children are particularly susceptible to pneumothorax because of its smaller airway anatomy, thin pleura, immature fragile lungs, complaint chest wall, higher exposure to positive pressure ventilation. Early recognition and preventive strategies are critical to reducing morbidity and mortality.