Journal List > Allergy Asthma Respir Dis > v.7(1) > 1125519

Allergy Asthma Respir Dis. 2019 Jan;7(1):51-56. Korean.
Published online Jan 30, 2019.
© 2019 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Clinical characteristics of pediatric pneumothorax during a noninvasive positive pressure ventilation
Bo Ra Lee,1 So Hyun Shin,1 Min Jung Kim,1 Eunji Kim,1 Yun Jung Choi,2 June Dong Park,1 and Dong In Suh1
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
2Sowha Children's Hospital, Seoul, Korea.

Correspondence to: Eunji Kim. Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-3778, Fax: +82-2-2072-3917, Email:
Received Sep 28, 2018; Revised Oct 22, 2018; Accepted Oct 22, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (



Noninvasive positive pressure ventilation (NIPPV) is one of the ventilation-supporting methods by providing adequate exogenous pressure without intubation or tracheostomy. We aimed to assess the frequency and clinical factors for pneumothorax occurring during NIPPV application in a tertiary children's hospital.


We selected cases of pneumothorax related to NIPPV by keyword searching in our institution's clinical data warehouse, and their medical records were retrospectively reviewed.


During a period of 17 years, 15 cases undergoing NIPPV developed pneumothorax, which was an incidence of 0.64% (15 of 2,343). There were 9 neonates and 6 adolescents. In 9 neonates, pneumothorax was caused by the continuous positive airway pressure (CPAP) ventilator, and occurred on 2 days after birth (median, range 1–3 days). In neonates, pneumothorax developed within 36 hours after CPAP application. One neonate underwent tracheal intubation and 3 neonates underwent chest tube insertion. In the postteenager group, pneumothorax developed 23 months (median, range 5 days to 47 months) after NIPPV application with a mask. All of the 6 patients had underlying neuromuscular disorders and one had superimposed interstitial lung disease. One of the 7 cases underwent surgical treatment and 4 cases were intubated. One case died from the deterioration of underlying interstitial lung disease.


Although it rarely happens, the NIPPV can result in pneumothorax. In most cases, it can be resolved by supportive cares with oxygen or chest tube with or without tracheostomy. The prognosis is related to the type of underlying disease and its progression.

Keywords: Noninvasive ventilation; Pneumothorax; Respiratory insufficiency


Fig. 1
Flow chart of subjects being anlyzed. NIPPV, noninvasive positive pressure ventilation; NICU, neonatal intensive care unit.
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Table 1
Keywords used in defining the case of pneumothorax associated with the noninvasive positive airway pressure ventilatory support
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Table 2
Demographic and clinical characteristics of study patients
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Table 3
Comparison of ventilator mode and setting values between the 2 groups
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Table 4
Comparison of treatment and procedures between the 2 groups
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