Prospective evaluation of lung function in children with parapneumonic empyema (original) (raw)
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Management of Childhood Empyema as a Complication of Community Acquired Pneumonia
The Medical Journal of Cairo University, 2018
Background: Pneumonia is one of the most common reasons for hospitalization in childhood. Although most bacterial pneumonia will resolve with treatment of the underlying infection, some cases will be complicated by the development of an empyema. Aim of Study: To assess the degree of agreement of the lines of diagnosis and treatment of patients with complicated pneumonia and empyema with the European guidelines for management of childhood empyema. Patients and Methods: This study is a prospective analysis of 60 patients of empyema that were diagnosed and managed at Assuit University Children Hospital over 12 months from 1 st March 2016-28th February 2017. Results: History of prolonged pneumonic illness (>15 days) and pleuritic pain were checked in 100% and 86.7% respectively. History of the cardinal signs (cough, fever and respiratory distress) and investigations as CXR, WBC count, blood culture, CRP and ESR of community acquired pneumonia was taken in 100%, 100%, 100%, 75%, 41.7% and 41.7% respectively. ELISA test and procalcitonin were not done in any of our patients. History of the lines of management of community acquired pneumonia was taken in 60% of patients. Investigations of empyema as CXR, chest CT scan, analysis of pleural fluid, chest ultrasound, sputum culture were done in 100%, 100%, 75%, 21.7, 8.3% successively. Eighty five % were treated correctly by antibiotics and 65%operated on by chest tube drainage and 1.6% was operated upon by open thoracotomy with decortications. Fibrinolytic therapy was not done in any of our patients. Conclusion: Empyema is still a respiratory problem in pediatrics. Evaluation of the studied patients were done perfectly except for some history points and some laboratory investigations that showed some defects. Management was perfectly done except for fibrinolytic therapy.
Journal of Pediatric and Adolescent Surgery, 2022
Background: Chronic empyema thoracis (CET) is common in developing and developed countries despite advancement in diagnostic and therapeutic technologies. Some of the cases of CET can be managed with antibiotics and tube drainage alone, some of them managed with less extensive surgical procedure like video-assisted thoracoscopic surgery (VATS) or open decortication alone, while some of the complicated cases need extensive decortication and debridement of necrotic lung tissue or lobectomy. Our aim is to present our experience of management of cases of chronic empyema thoracis in children. Methods: This is a retrospective observational study of cases, managed at tertiary care center with chronic empyema thoracis. Records of cases of CET admitted, referred or transferred to department of pediatric surgery at our center over last three years were studied. Demographic data, clinical, radiological profile, surgical/ non-surgical intervention, hospital stay, aetiology, outcome was analysed. Follow up was up to the last recorded outpatient visit. This study is a retrospective observational study with small number of cases statistical tool are not used to draw any statistical interference. Results: Twenty-nine cases with median age 3 years, male to female ratio was 25:4 were admitted over three years. Preoperative bronchopleural fistula was seen in four. Five cases were managed conservatively, twenty underwent decortication alone while four cases required decortication along with lobectomy. Tuberculosis was detected in three cases. A pyogenic organism was identified in ten cases only. Post-operative ventilation was required in three patients. There was no mortality. All thrived well at 12-18 months follow up. Conclusion: Management of chronic empyema should be case based. Cases of CET in children can managed with conservative (with appropriate drainage of cavity, proper antibiotics, and nutritional build-up of child), thoracotomy and decortications alone or some time removal of disease lung also required depending on clinical and radiological finding of cases.
Empyema thoracis in children: analysis from a tertiary care center
International Journal of Contemporary Pediatrics
Background: Empyema thoracis refers to infection and pus formation within the pleural space in the thorax. It is estimated that 0.6% of childhood pneumonia’s progress to empyema, affecting 3.3 per 100000 children. The purpose of this study was to analyse the clinical and bacteriological profile, outcome of empyema in children with reference to intercostal drainage/tube thoracostomy (ICD/TT) and video assisted thoracoscopic surgery (VATS).Methods: A hospital based prospective comparative study was conducted on 61 children diagnosed with empyema thoracis according to ICD-10 code J869 between 6 months to 18 years of age admitted to K. G. P. children hospital, Vadodara over a period of 20 months from September 2018 to May 2020.Results: Most of patients (63.9%) were seen in age group of 1-5 years. Fever (100%), cough (99%) and breathlessness (85%) were the commonest presenting features. Pleural fluid culture was positive in (28%) of patients and Staphylococcus aureus (11.5%) was the most...
Poorly Treated Broncho-Pneumonia with Progression to Empyema Thoracis in Nigerian Children
AIM: Poorly treated bronchopneumonia is the most common cause of empyema thoracis in Nigeria. Ignorance poverty and quackery are the major reasons for inadequate treatment. METHOD: All paediatric patients diagnosed and treated for empyema thoracis secondary to poorly treated bronchopneumonia in our hospital between November 2006 and January 2009 had their case notes retrieved, and data collated into individual proforma for analysis. RESULTS: During the 26 months period, there were 2106 admissions into children emergency unit of our hospital, with 267 having bronchopneumonia (12%) and 18 having empyema thoracis (6.7% case prevalence). The age range was 1 month to 16 years with mean of 6.4 years and male: female ratio 3.5: 1. The right pleural space was affected in 50%, left pleural space in 33.33%, and both pleural spaces in 16.66%. Up to 61% of mothers of the patients with empyema thoracis had no or only primary level of formal education, 77.78% of such mothers were not gainfully employed and 44.43% of patients were previously treated by medical charlatans before presentation in our hospital. All patients were successfully treated with antibiotic and tube thoracostomy drainage with satisfactory recovery. CONCLUSION: Empyema thoracis 20 poorly treated bronchopneumonia is still prevalent in Nigeria. Mass literacy campaign, poverty alleviation and provision of affordable and easily accessible medical care throughout the whole country are the immediate solution to this menace. ÖZET AMAÇ: Nijerya'da iyi tedavi edilmemiş bronkopnömoni torasik ampiyemin en sık karşılaşılan nedenidir. Yoksulluk ve sahte doktorluk bu durumun en sık karşılaşılan nedenleri olarak karşımıza çıkmaktadır. METOD: Kasım 2006 ile Ocak 2009 arasında pediatrik hastaların tamamı bronkopnömoni ve iyi tedavi edilmemiş bronkopnömoniye bağlı torasik ampiyem yönünden incelendi. Hastalar ile ilgili alınan notlar analiz edilmek üzere hasta dosyalarından ayrı olarak saklandı. BULGULAR: Araştırmanın gerçekleştirildiği 26 ay boyunca çocuk acil servisine başvuran 2106 hastanın 267 sinde (%12) bronkopnömoni ve 18 inde (%6,7) torasik ampiyem tespit edilmiştir. Katılımcıların yaş dağılımı bir ay 16 yaş arasında olup, ortalama yaş 6,4'tür. Erkek-Kadın oranı ise 3,5: 1 olarak bulunmuştur. Ampiyemin vakaların %50'sinde sağ tarafta, %16,66'sında sol tarafta, %33,33'ünde ise her iki tarafta görülmüştür. Hastalık tespit edilenlerin velilerinin %61'inin herhangi bir eğitim almadıkları, %77,78'inin çalışmadıkları ve hastaların %44,43'ünün hastaneye başvuru öçncesi sahte doktorlar tarafından tedavi edilmeye çelışıldıkları saptanmıştır. Tüm hastalar antibiyotik ve tüp trakeostomi tedavisi ile tedavi edilmişlerdir. SONUÇ: Nijerya'da iyi tedavi edilmemiş bronkopnömoniden kaynaklanan 20 torasik ampiyem problemi halen devam etmektedir. Yoğun kampanyalar, yoksulluğun azaltılması, gelişmiş ve ulaşılabilir bir sağlık hizmet sisteminin bu tehdidin çözümünde etkili olacağı değerlendirilmektedir.
Indicators for surgical intervention in thoracic empyema in children
Saudi Medical Journal, 2015
The data extracted included: socio-demographic data, clinical data, method of treatment, and follow up data. According to the introduced therapeutic methods, a total of 62 patients were divided into 2 groups; patients treated with chest tube)CT(insertion)51 cases(, and 11 cases that required thoracotomy)TH(; groups were compared to determine predictors for thoracotomy. Results: Of 62 patients, 37 were females and 25 were males. In terms of age, side of lesion, presence of cough, or dyspnea, both groups were homogenous. Both groups had significant differences for duration of complaint)TH and CT()13.5±6.5 days versus 10±3.6, p=0.005(, presence of fever)90.2% versus 36.4%, p<0.001(, history of recurrent chest infections)90.9% versus 37.3%, p=0.001(, and radiological findings. However, it was not evident that any of these variables influenced treatment decision except absence of fever, which was significantly less in patients treated with thoracotomy. Conclusion: No specific indicator was found to increase expectancy for surgical intervention as a treatment choice, except the absence of fever, which may reflect the delayed referral and prolonged use of antibiotics and cannot be interpreted truly without caution as an indicator for surgical intervention.
Clinical practice: treatment of childhood empyema
European Journal of Pediatrics, 2009
Introduction The incidence of empyema in children is increasing. Adequate knowledge of treatment modalities is therefore essential for every pediatrician. At the university hospital of Leuven, the incidence per 100,000 admissions increased from 40 in 1993 to 120 in 2005. The treatment of choice, however, is still a matter of debate. This is mainly due to the scarcity of prospective randomized trials in children but is further complicated by the absence of uniform terminology. This review starts with clarifying definitions of empyema and complicated versus noncomplicated parapneumonic effusion. The place of different imaging techniques-ultrasound, chest X-ray, computerized tomography and magnetic resonance imaging-is illustrated. All treatment steps are evaluated starting with antibiotic choices, duration of i.v. and oral antibiotics, pleural fluid analysis, indications for chest drain placement, and fibrinolysis. As to the surgical interventions, there is at present insufficient evidence that early surgery is superior to noninvasive medical treatment. Therefore, video-assisted thoracoscopy cannot be advised as general first-line therapy. Conclusion Since the pathogenicity of empyema is a dynamic process, therapeutic strategy must be decided based on empyema stage and clinical experience. Each referral center should agree on a diagnostic and therapeutic flowchart based on current evidence and local expertise. The flow chart outlined for our center is presented.
Should Empyema with or without Necrotizing Pneumonia in Children Be Managed Differently?
Health, 2017
Background: Necrotizing pneumonia (NP) is an increasing lung infection mostly associated with pleural empyema. Objectives: We aimed to compare children with empyema with and without concomitant NP, in terms of risk factors, management and outcome. Methods: We retrospectively included children hospitalized between 2005-2014 with empyema to whom a computed tomography was performed. We recorded patient characteristics, clinical, biological (blood and pleural fluid) and radiological findings, medical and surgical treatments, and clinical, radiological and functional follow-up. Results: 35 children with empyema were included, including 25 with a concomitant NP. Patients with or without NP were undistinguishable, in terms of characteristics, symptoms at admission or detected pathogens. Pleural leucocytes were significantly higher in the empyema group (p = 0.0002) as pleural LDH (p = 0.002), and pleural/blood LDH ratio (p = 0.0005). Medical and surgical managements were similar between both groups. Complications occurred in 1/10 children with empyema alone (pneumatocele) and 5/25 with concomitant NP (bronchopleural fistula (n = 3), lobectomy, pneumothorax). The hospital length of stay and delay for chest X-ray normalization were similar in both groups. Conclusion: Except for minor biological parameters, the presence of concomitant NP in case of empyema does not change the presentation, clinical features, management and outcome, suggesting that the presence of additional NP to empyema should not be managed differently. Therefore, in case of empyema with suspected concomitant NP, chest CT should probably be restricted to abnormal worsening or when mandatory for surgical treatment.
Empyema Thoracis in Children: Clinical Presentation, Management and Complications
To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan. Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated. Results: Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications. Conclusion: Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management.
Current treatment of pediatric empyema
Seminars in thoracic and cardiovascular surgery, 2004
Pneumonia with complicated parapneumonic effusion and empyema is increasing in incidence and continues to be a source of morbidity in children seen in our institution. Current diagnostic modalities include chest radiographs and CT scanning with ultrasound being helpful in some situations. Exact management of empyema remains controversial. Although open thoracotomy drainage is well accepted in children, video-assisted thoracoscopic surgery (VATS) drainage has become more prevalent in the current era. Over the last 4 years, we have treated 58 children with intrapleural placement of pigtail catheters and administration fibrinolytics consisting of tissue plasminogen activator (tPA). Successful drainage and resolution of 54 of the 58 effusions was achieved with percutaneous methods alone. There was no mortality or 30-day recurrence. Mean hospital stay was 9.1 days (range 5 to 21) and mean chest catheter removal was 6 days post placement (range 1.5 to 20). Of the four patients that failed...
Pediatric empyema thoracis: our surgical experience
International Surgery Journal, 2021
Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed. Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of trea...