Pediatric Pneumothorax Medication
- Author: William Gluckman, DO, MBA, FACEP; Chief Editor: Michael R Bye, MD more...
The only drug therapy that is currently a component of the standard of care for pneumothorax is administration of 100% oxygen. Patients with a thoracostomy tube in place should receive appropriate pain management, and patients in severe pain should receive morphine sulfate intravenously or a patient-controlled analgesia pump when appropriate. Some patients' pain can be controlled well with oral medications such as acetaminophen.
A study by Halliday et al examined the role of early postnatal corticosteroids in preventing chronic lung disease and found that some of these agents can result in pneumothorax as well as other potential or known adverse effects.
Pain management is necessary for patients with a thoracostomy tube in place. Intravenous morphine sulfate should be administered in patients who experience severe pain. Pain can also be controlled with oral acetaminophen in some patients.
Morphine is an opioid analgesic that exerts its pharmacologic effects on the CNS and GI tract. It is a drug of choice for analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone.
Acetaminophen is effective in relieving mild to moderate acute pain; however, it has no peripheral anti-inflammatory effects.
Flume PA. Pulmonary complications of cystic fibrosis. Respir Care. 2009 May. 54(5):618-27. [Medline].
Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000 Mar 23. 342(12):868-74. [Medline].
Al Tawil K, Abu-Ekteish FM, Tamimi O, Al Hathal MM, Al Hathlol K, Abu Laimun B. Symptomatic spontaneous pneumothorax in term newborn infants. Pediatr Pulmonol. 2004 May. 37(5):443-6. [Medline].
Peng W, Zhu H, Shi H, Liu E. Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2014 Mar. 99 (2):F158-65. [Medline].
[Guideline] Finnish Medical Society Duodecim. Differential diagnosis of chest pain. EBM Guidelines. 2008 May 16. [Full Text].
Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005 Sep. 12(9):844-9. [Medline].
Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?. Am J Surg. 2014 Oct. 208 (4):571-6. [Medline].
Chang SJ, Ross SW, Kiefer DJ, Anderson WE, Rogers AT, Sing RF, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014 Apr. 76 (4):1029-34. [Medline].
Miller AC, Harvey JE. Guidelines for the management of spontaneous pneumothorax. Standards of Care Committee, British Thoracic Society. BMJ. 1993 Jul 10. 307(6896):114-6. [Medline].
Halliday HL, Ehrenkranz RA, Doyle LW. Early (< 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009 Jan 21. CD001146. [Medline].