title: Iatrogenic pneumothorax in mechanically ventilated children: Incidence, risk factors and other outcomes.
abstract: OBJECTIVE
  Determine prevalence, risk factors and outcomes of iatrogenic pneumothoraces (IPs) in a pediatric intensive care unit (PICU).
  
  
  METHODS
  Patients with IP (cases) and patients without IP (controls) were retrieved from a 5-year prospective cohort of 645 PICU patients who received mechanical ventilation (MV).
  
  
  RESULTS
  Twenty cases and eighty controls were assessed. The overall prevalence of IP was 3%. Eleven IPs were procedure-related IP and 9 MV related. Performance of thoracic invasive procedures (odds ratio 11) was the significant IP predictor in the logistic regression analysis. IP incidence was higher within 12 hours. There were no differences between the groups concerning duration of MV, length of PICU and hospital stays. IP patients had a significantly higher mortality rate (p = 0.005).
  
  
  CONCLUSIONS
  Performance of thoracic invasive procedures was strongly associated with IPs events in mechanically ventilated children. Many of these events may potentially be preventable with the implementation of quality improvement programs.
authors: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, Rua Castro Alves, 60, São Paulo 01532-900, Brazil. Electronic address: psls.nat@terra.com.br.
authors: Paulo Sérgio Lucas
authors: PS
authors: da Silva
authors: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, Rua Castro Alves, 60, São Paulo 01532-900, Brazil.
authors: Vânia Euzébio
authors: VE
authors: de Aguiar
authors: Department of Pediatrics, Pediatric Intensive Care Unit, Universidade Federal de São Paulo, Brazil.
authors: Marcelo Cunio Machado
authors: MC
authors: Fonseca
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors
keywords: Children; Iatrogenic pneumothorax; Mechanical ventilation; Pediatric intensive care unit; Quality improvement