Persistent pulmonary air leak in the pediatric intensive care unit: Characteristics and outcomes

Shelly Kagan, Eytan Kaplan, Gili Kadmon, Yulia Gendler, Avichai Weissbach

Research output: Contribution to journalArticlepeer-review


Background: Persistent air leak (PAL) complicates various lung pathologies in children. The clinical characteristics and outcomes of children hospitalized in the pediatric intensive care unit (PICU) with PAL are not well described. We aimed to elucidate the course of disease among PICU hospitalized children with PAL. Methods: A retrospective cohort study of all PICU-admitted children aged 0–18 years diagnosed with pneumothorax complicated by PAL, between January 2005 and February 2020 was conducted at a tertiary center. PAL was defined as a continuous air leak of more than 48 h. Results: PAL complicated the course of 4.8% (38/788) of children hospitalized in the PICU with pneumothorax. Two were excluded due to missing data. Of 36 children included, PAL was secondary to bacterial pneumonia in 56%, acute respiratory distress syndrome (ARDS) in 31%, lung surgery in 11%, and spontaneous pneumothorax in 3%. Compared to non-ARDS causes, children with ARDS required more drains (median, range: 4, 3–11 vs. 2, 1–7; p <.001) and mechanical ventilation (100% vs. 12%; p <.001), and had a higher mortality (64% vs. 0%; p <.001). All children with bacterial pneumonia survived to discharge, with a median air leak duration of 14 days (range 3–72 days). Most of which (90%) were managed conservatively, by continuous chest drainage. Conclusion: Bacterial pneumonia was the leading cause of PAL in this cohort. PAL secondary to ARDS was associated with a worse outcome. In contrast, non-ARDS PAL was successfully managed conservatively, in most cases.

Original languageEnglish
Pages (from-to)2729-2735
Number of pages7
JournalPediatric Pulmonology
Issue number8
StatePublished - Aug 2021


  • Broncho pleural fistula
  • alveolopleural fistula
  • pediatric intensive care unit
  • persistent air leak

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Pediatrics, Perinatology, and Child Health


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