Management of postpneumonic empyemas in children.

Department of Thoracic Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
European Journal of Cardio-Thoracic Surgery (Impact Factor: 2.81). 07/2004; 25(6):1072-8. DOI: 10.1016/j.ejcts.2003.12.025
Source: PubMed

ABSTRACT Despite continued improvement in medical therapy, pediatric empyema remains a challenging problem for the surgeon. Multiple treatment options are available; however, the optimal therapeutic management has not been elucidated. The aim of this study is to assess different treatment options in the management of postpneumonic pediatric empyemas.
A retrospective review was performed of pediatric patients admitted to Dicle University School of Medicine Thoracic and Cardiovascular Surgery Department between 1990 and 2002, with the diagnosis of empyema. Data tabulated included patient demographics, presentation, treatment and outcome.
There were 515 children (289 boys and 226 girls) with a mean age of 4.7 ranging from 18 days to 15 years. Empyema was secondary to pneumonia in all children. The most common radiologic finding was pleural effusion in 285 patients (55.32%). Staphylococcus aureus was the most frequently encountered organism and found in 105 patients (20.38%). Pleural fluid cultures were negative in 195 patients (37.86%). In addition to antibiotic therapy, initial treatment included serial thoracenthesis (n = 29), chest tube drainage alone (n = 214), chest tube drainage with intrapleural fibrinolytic therapy (n = 72), chest tube drainage with primary operation (n = 191), and primary operation without chest tube drainage (n = 9). Overall response rate with fibrinolytic treatment (complete and partial response) was obtained in 58 patients. In addition to decortication pulmonary resections were performed in 12 patients. Overall mortality rate was 1.55%. There was no operative mortality. Postoperative morbidity included wound infection in 21, delayed expansion in 8, and atelectasis in 35 patients.
Multiple therapeutic options are available for the management of pediatric empyema. Depending on stages, every option has a role in the treatment of postpneumonic pediatric empyema. In the absence of bronchopleural fistula, intrapleural fibrinolytic treatment should be tried in all patients with multiloculations in stage II empyema. In the absence of pneumonia, decortication for empyema is a safe approach with low mortality and morbidity rates.

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    ABSTRACT: Abstract Pneumonia is one of the most frequent reasons for hospitalizing children. According to many studies, between 28.3–60 % of all cases with children, hospitalized with CAP, had been complicated with effusion/empyema. That represented diagnostic and therapeutic challenge. The goal of article is to reveal the role of transthoracic ultrasound examination (TUE) in determination of the stage of the parapneumonic effusion/empyema, as well as time and the type of surgical intervention in children. Materials and methods: Between January 2005 – December 2010 at the Paediatric thoracic surgery department of „Pirogov” University hospital, had been treated 170 children with clinical and radiological signs of parapneumonic effusion and empyema. TUE was performed with high frequency linear probes (5–13 MHz) and broadband convex probes (3–6 MHz). Findings were evaluated according to established by us classification in four stages /modification of the classification of Hilliard (2003). Results: In 42 of the cases we found anechoic collection without septations (free fluid) – stage 1. In 91 children, at stage 2, we found heterogenous content of the pleural cavity/septations/, but we discovered thickened parietal in 35 children. That finding made us split this group into two – 2a and 2b, according to absence or presence of thickened parietal pleura. 37 children wеre determined with stage 3. Conclusions: Compared to other imaging modalities ultrasounography is broadly available, low cost and nonionizing examination. Transthoracic ultrasound examination gives accurate and dynamic evaluation of the pleural effusion and determines the exact stage of the parapneumonic effusion and empyema in children. The protocol accepted in our hospital for management of parapneumonic effusion and empyema in children significantly optimized the diagnostic imaging and treatment. Key words: Transthoracic ultrasound examination, pleural effusion, empyema, ultrasound.
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    ABSTRACT: Background Parapneumonic empyema thoracis is a rare complication of bacterial pneumonia in children that emencely increases the morbidity. Classically parepneumonic effusions are divided into three stages. Stage I or exudative stage, Stage II or fibrinopurulent stage and stage III or organised effusion stage. The present study was designed to highlight the role of open decortication by thoracotomy in cases of para-pneumonic empyema of stage II and stage III disease in children. Methods A prospective observational study was done on 31 children of less than 15 years of age, who presented with stage II and stage III parapneumonic empyema thoracis. They underwent decortication surgery through postero-lateral thoracotomy. Results Out of the 31 children included in this study, there were 21 boys (67.74 %) and 10 girls (32.26 %). The average duration of symptoms was 17.84 days. The mean duration of post-operative chest drain was 2.55 days. Staphylococcus aureus was the most frequently encountered organism isolated in culture of fibrino-purulent material from the pleural cavity in 12 cases (38.7 %). Mean duration of total hospital stay was 8.3 days. Conclusion Decortication by thoracotomy is a safe and effective approach for stage II & III parapneumonic empyema thoracis in children leading to early recovery and less hospital stay.
    Indian Journal of Thoracic and Cardiovascular Surgery 12/2013; 29(4). DOI:10.1007/s12055-013-0257-6


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