Tratamento cirúrgico de pneumonia necrosante em crianças em um período de 10 anos

Abstract

Objective: Necrotizing pneumonia (PNZ) is a severe and rare complication of a community-acquired pneumonia, affecting mainly children. We aimed to analyze medical records of children undergoing surgical treatment for PNZ and compare our results with those found in the medical literature. Methods: Retrospective analysis of children's medical charts who underwent an operation for PNZ, between July 2006 and July 2016, in two hospitals in southern Santa Catarina, Brazil. Results: A total of 26 children with a median age of 2.70 years and mostly females (61.5%) were included in the current study. The main symptoms were fever (88.5%) and cough (65.4%). There was an average use of 4.31 antibiotics per patient. The primary etiological agent was Staphylococcus aureus (23.1%), but cultures were negative in 69% of the patients. Decortication and debridement of necrotic areas were performed in 23 patients (88.5%). The mean postoperative pleural drainage was 8.12 days. The presence of bronchopleural fistula occurred in 50.0% in the preoperative period and 46.2% in the postoperative. The total length of hospital stay was, on average, 27.52 days and the postoperative length of stay was 12.60 days (mean). Postoperative complications occurred in 13 children and there was no mortality. Conclusion: The surgical approach is indicated to patients with no response to clinical treatment. Late surgical intervention is associated with progressive parenchyma infection and higher rates of complications. Surgery can lead to better clinical outcomes and earlier recovery. Dalponte Surgical treatment of necrotizing pneumonia in children: a 10-year assessment 2 Rev Col Bras Cir 47(1):e20202374 The therapeutic approach of a PNZ remains a challenge due to the limited number of available data. The initial treatment is conservative. However, when there is no complete response to the treatment or there are complications, surgical intervention is necessary 4,5 . Although PNZ has high morbidity in its acute stage, leading to a prolonged hospital stay, the use of antibiotics along with the surgical intervention, in the long term, are associated to an excellent prognosis with low mortality. A total clinical recovery and minimal remnants of disease in imaging follow-ups are seen 7 . The knowledge about the clinical characteristics and the therapeutic approaches is based on a few reports in the literature, making it a relatively rare disease 8,9 . Therefore, this study aimed to analyze the data of children undergoing surgical treatment for PNZ, and compare the results with those found in the medical literature. Palavras chave: Pneumonia Necrosante/cirurgia. Pneumonia/complicações. Empiema. Criança. Dalponte Surgical treatment of necrotizing pneumonia in children: a 10-year assessment 10 Rev Col Bras Cir 47(1):e20202374

Aplicativos Móveis Para Educação Em Saúde Em Pessoas Com Diabetes Mellitus Tipo 2: Uma Revisão Integrativa

“…Chamou a atenção dos discentes o fato da paciente apresentar apenas 99.340 mil plaquetas mesmo após o recebimento do concentrado, o que é considerado um valor baixo mesmo para uma criança. A média de antibióticos utilizados no caso dessa paciente apresenta-se em quantidade semelhante a outros estudos (BARREIRA et al, 2002;DALPONTE et al, 2020).…”

Pneumonia Necrotizante em Pré- escolar: relato de caso

“…A pneumonia pneumocócica na faixa pediátrica raramente cursava com uma necrose pulmonar, fato esse que vem apresentando mudanças atualmente, visto que os casos que evoluem para tal complicação vêm aumentando em crianças que são acometidas principalmente pelo S. pneumoniae. Outra explicação para tal fato é a presença de cepas cada vez mais virulentas que não são cobertas pelo programa nacional de imunização 3,4 .…”

“…Contudo, na faixa etária pediátrica, a epidemiologia da pneumonia necrotizante está vinculada a casos que acometem crianças pequenas, mesmo que previamente saudáveis e sem os fatores de risco associados 1 . Acreditase que essa ascensão na pediatria possa estar associada com a introdução da vacinação contra o Pneumo10 no Programa Nacional de Imunização, resultado em uma seleção de cepas mais virulentas não cobertas pela vacina 4 .…”

Necrotizing Pneumonia in Children: Early Recognition and Management

“…Surgical treatments of pediatric NP are recommended in cases where there is the presence of complications or no complete response to the conservative treatment. A study found that a delay in surgery is associated with more complications and recommended an early intervention [ 136 ]. Early thoracoscopy may hasten recovery and avoid late lung resections [ 137 ].…”