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Three Part Question

In [children with radiological evidence of pneumomediastinum] is [admission for oxygen therapy better than ambulatory observation] at [relieving symptoms and speeding removal of air from the mediastinum]?

Clinical Scenario

A 14 year old girl presents to the Paediatric Emergency Department with cough, chest pain and neck pain. Chest Radiograph demonstrates pneumomediastinum and surgical emphysema in the neck. She is booked onto a transatlantic flight for five days time. To aid resolution of the mediastinal air she is admitted for oxygen therapy.

Search Strategy

Medline searched via Pub Med interface on 5th August 2010
Medline: 'spontaneous pneumomediastinum' [MeSH] and 'oxygen therapy' with no limits produced 26 results, of which none were relevant.

'spontaneous pneumomediastinum' [MeSH] and 'children' produced 106 results, of which none were relevant.

Search Outcome

No relevant published studies were found which expressly addressed the clinical question. Four retrospective case series were found which described the management of spontaneous pneumomediastinum (Evidence level 4)

Comment(s)

No evidence exists to guide management of spontaneous pneumomediastinum. There is no evidence to support prophylactic supplementary oxygen therapy.

Clinical Bottom Line

There is no evidence to support prophylactic oxygen in spontaneous pneumomediastinum to aid resolution of symptoms or radiographic appearance. Patients should be individually assessed and local guidelines followed.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.