Aspiration in the Treatment of Empyema in Children

Abstract

In 1929 we 1 reported a series of thirty-three consecutive cases of empyema in children, with a mortality of 9.1 per cent. Of these patients, twenty-eight, or 85 per cent, were cured by aspiration alone. One infant of 4 months of age recovered by spontaneous rupture through a bronchus. One older child was operated on after a number of aspirations had been done because the heart remained far to the right of its normal position. In the light of subsequent experience we feel sure that this child, too, would have recovered by aspiration alone. There were three deaths. One of these occurred in a child who went home against advice and died a week later; the second in an infant who died of pneumococcus septicemia and meningitis and in whom the incidental empyema cavity had a capacity, at autopsy, of less than 1 fluid ounce (30 cc.), and the third in an older child, who had a prolonged bilateral pneumonia and empyema, was for weeks in a Warren Collins oxygen tent and was at all times so critically ill that the surgeon did not think it safe to operate. We were naturally encour¬ aged to continue a method of treatment that had given us results such as we had never approximated with the usual surgical procedures. We were, however, and so stated, fully cognizant of the yearly and seasonal vagaries of infection, and we were therefore interested in seeing whether our experience of one year represented a norm or was the result of a peculiarly favorable year. It is our present purpose to report our experience over three calendar years, a period that would seem long enough to tend to iron out to some degree the differences resulting from yearly variations of infection.The total series comprises ninety-four consecutive cases of empyema in children treated by aspiration, to those occurring in 1928 being added thirty-one in 1929 and thirty in 1930. Our method of pro-From the Children's Memorial Hospital.