Early definitive intervention by thoracoscopy in pediatric empyema

Merry, Christine; Bufo, Anthony J.; Shah, Rasik; Schropp, Kurt P.; Lobe, Thom E.

doi:10.1016/s0022-3468(99)90252-x

Cited by 74 publications

(48 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(5,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) In children for whom thoracoscopy was insufficient to produce clinical improvement, and in whom a second surgical procedure was required, another thoracoscopy was always the first choice. This was not possible in some children, since complicated parapneumonic pleural effusion had evolved to the organized stage, with lung entrapment, and thoracotomy or thoracostomy was therefore required.…”

Section: Discussionmentioning

confidence: 99%

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

2009

View full text Add to dashboard Cite

Objective: To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. Methods: Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between November of 1995 and July of 2005. The mean age was 2.6 years (range, 0.4-12 years), and 60% were males. Thoracoscopy was performed at three different hospitals following the same treatment algorithm. Results: Thoracoscopy was effective for 87 children (88%). In 12 (12%), a second surgical procedure was required: another thoracoscopy (n = 6) or thoracotomy/thoracostomy (n = 6). Mean duration of chest tube drainage following successful thoracoscopy was 3 days vs. 10 days in patients submitted to a second procedure (p < 0.001). In all of the children, the pleural infection resolved after treatment. Thoracoscopy-related complications included air leak (30%), chest tube bleeding (12%), subcutaneous emphysema associated with trocar insertion (2%) and surgical wound infection (2%). None of the children required additional surgical procedures due to the complications. Conclusions:The effectiveness of thoracoscopy in children with parapneumonic pleural effusion at the fibrinopurulent stage was 88%. The procedure was safe, with a low rate of severe complications. Thoracoscopy should be the first-choice treatment for children with parapneumonic pleural effusion at the fibrinopurulent stage.Keywords: Thoracoscopy; Pleural effusion; Empyema, pleural. ResumoObjetivo: Determinar a eficácia da toracoscopia em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta entre novembro de 1995 e julho de 2005. A média de idade foi de 2,6 anos (variação, 0,4-12 anos) e 60% eram do sexo masculino. A toracoscopia foi realizada em três hospitais diferentes utilizando-se o mesmo algoritmo de tratamento. Resultados: A toracoscopia foi eficaz em 87 crianças (88%) e 12 (12%) necessitaram de outro procedimento cirúrgico: nova toracoscopia (n = 6) ou toracotomia/pleurostomia (n = 6). O tempo médio de drenagem torácica foi de 3 dias nas crianças em que a toracoscopia foi efetiva e de 10 dias naquelas que precisaram de outro procedimento (p < 0,001). A infecção pleural de todas as crianças foi debelada após o tratamento. As complicações da toracoscopia foram fuga aérea (30%) e sangramento pelo dreno torácico (12%), enfisema subcutâneo na inserção do trocarte (2%) e infecção da ferida operatória (2%). Nenhuma criança necessitou de reoperação devido às complicações. Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 88%. O procedimento mostrou-se seguro, com baixa taxa de complicações graves, devendo ser considerado como primeira opção em crianças com DPPC na fase fibrinopurulenta. Original ArticleThoracoscopy in childre...

show abstract

Section: Discussionmentioning

confidence: 99%

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

2009

View full text Add to dashboard Cite

show abstract

“…Klena et al 19 sugerem que o procedimento seja indicado precocemente em derrames septados, após a drenagem torácica, em crianças que permaneçam doentes. Merry et al 28 , em revisão de 23 crianças com empiema submetidas à toracoscopia, relatam que, em 19 destas crianças, a toracoscopia foi indicada como procedimento inicial de drenagem. A indicação da toracoscopia foi a presença de derrame loculado, diagnosticado pela insuficiência de drenagem de todo o líquido através da toracocentese, ou através de radiografia de tórax, ecografia ou tomografia computadorizada 28 .…”

Section: Toracoscopiaunclassified

“…Merry et al 28 , em revisão de 23 crianças com empiema submetidas à toracoscopia, relatam que, em 19 destas crianças, a toracoscopia foi indicada como procedimento inicial de drenagem. A indicação da toracoscopia foi a presença de derrame loculado, diagnosticado pela insuficiência de drenagem de todo o líquido através da toracocentese, ou através de radiografia de tórax, ecografia ou tomografia computadorizada 28 . Subramaniam et al 25 recentemente compararam toracoscopia com toracotomia em crianças com empiema, e observaram que a toracoscopia reduz significativamente o tempo cirúrgico, a necessidade de ressecções pulmonares, a perda sangüínea transoperatória e a necessidade de transfusão de sangue, a necessidade de analgésicos, a duração da drenagem torácica e o tempo de internação hospitalar.…”

Section: Toracoscopiaunclassified

See 1 more Smart Citation

Abordagem cirúrgica da efusão pleural parapneumônica e suas complicações

Fraga¹,

Kim

2002

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

Objective: surgical treatment of parapneumonic pleural effusion in children is controversial. The type of intervention is based mainly on personal experience and on the small number of reported cases. This article aims at presenting a literature review and the authors' experience in the surgical management of parapneumonic pleural effusion in children.Sources: data were searched in the Medline and Lilacs databases.Summary of the findings: complicated parapneumonic effusion should be surgically drained if thoracentesis reveals the presence of pus, positive Gram stain or culture, or pH less than 7.0 or glucose less than 40 mg/dl. The surgical drainage depends on the stage of parapneumonic pleural effusion: at the acute stage closed thoracostomy drainage is enough; at the fibrinopurulent stage thoracoscopy is indicated; at organizational stage thoracotomy can be performed in children with stable anesthetic conditions, and open thoracostomy drainage should be used in patients in a poor state of health. Echography is very important to evaluate the staging of parapneumonic effusion.Conclusions: surgical treatment of complicated parapneumonic effusion should be done as early as possible, and the kind of procedure depends on the stage of pleural effusion. In children with complicated parapneumonic effusion echography is very important to evaluate the staging of parapneumonic effusion.J Pediatr (Rio J) 2002; 78 (Supl.2): S161-S170: pleural effusion, surgical drainage, surgery. ResumoObjetivo: o tratamento cirúrgico do derrame parapneumônico na criança é controverso, sendo a abordagem baseada fundamentalmente na experiência pessoal e no pequeno número de casos relatados. O objetivo deste artigo é o de apresentar uma revisão bibliográ-fica dos principais trabalhos e experiência dos autores no tratamento cirúrgico do derrame parapneumônico na criança. Fonte dos dados: foram utilizados dados de artigos científicos pesquisados através dos bancos de dados Medline e Lilacs.Síntese dos dados: o derrame parapneumônico tem indicação de drenagem cirúrgica quando apresenta, à toracocentese, aspecto purulento, bactéria no Gram ou cultura, e análise bioquímica com pH menor que 7,0 e glicose menor que 40mg/dl. A drenagem cirúrgica depende da fase do derrame. Na fase aguda, é suficiente a drenagem torácica fechada; na fase fibrinopurulenta, é indicada toracoscopia; na fase organizada, a toracotomia é realizada em crianças com condições anestésicas, e a pleurostomia, naquelas debilitadas e com estado geral comprometido. A ecografia é útil, e, na maioria das vezes, fundamental, para definir a fase do derrame pleural.Conclusões: o tratamento cirúrgico do derrame parapneumôni-co complicado deve ser feito o mais precocemente possível, e o tipo de procedimento a ser realizado depende da fase do derrame pleural. Nas crianças que necessitam de drenagem cirúrgica, a ecografia é fundamental, para determinar a fase evolutiva do derrame parapneumônico.J Pediatr (Rio J) 2002; 78 (Supl.2): S161-S170: derrame pleural, drenagem postural, cirurg...

show abstract

“…Thoracoscopic drainage with the debridement of empyema is a popular method of treatment, widely used in children when conservative treatment fails. Many authors have suggested that additional thoracoscopy yields better results than tube thoracostomy alone for the primary treatment of empyema [3,4]. In our previous article we demonstrated the efficiency of our own technique utilizing balloon-assisted single-port thoracoscopy for debridement [5].…”

Section: Introductionmentioning

confidence: 85%

THORACIC SURGERY Which technique is the best for the surgical management of empyema thoracis in children?

Tander¹,

Bıçakçı²,

Günaydın³

et al. 2013

kitp

View full text Add to dashboard Cite

StreszczenieWstęp: Ocenione zostały różnice między jednoportowymi (single-port techniques -SPT) oraz dwuportowymi (two-port techniques -TPT) metodami usuwania ropniaka opłucnej u dzieci. Materiał i metody: Od 51 pacjentów z ropniakiem opłucnej (33 mężczyzn, 18 kobiet) pobrano następujące dane: wiek, płeć, wyniki badań przedmiotowych, typ torakoskopii, długość pobytu w szpitalu (lenght of stay -LOS) oraz czas trwania drenażu klatki piersiowej (duration of chest tube drainage -DCTD). Metodę SPT zastosowano u 14 pacjentów, a TPT u 37. W przypadku SPT jako narzędzie tnące używany jest sam teleskop. Podczas procesu oczyszczania do organizmu nie wprowadza się innych narzędzi. W przypadku TPT pierwszy otwór używany jest do wprowadzenia teleskopu, a drugi przeznaczony jest dla narzędzia chirurgicznego. Przez jeden z otworów wprowadzany jest następnie dren. Wyniki: U 24 pacjentów ropniak znajdował się w prawej czę-ści klatki piersiowej, natomiast u 25 pacjentów umiejscowiony był po lewej stronie. U dwóch pacjentów klatka piersiowa była obustronnie zajęta. W grupie SPT dren był usuwany z klatki piersiowej po średnio 13 dniach, natomiast w grupie TPT po średnio 11 dniach. Średni LOS wynosił odpowiednio 20 i 13 dni dla grup SPT i TPT. U 4 pacjentów z grupy SPT i 2 pacjentów z grupy TPT wystąpiły samoistnie ustępujące przetoki oskrzelowo-opłucnowe. Nie stwierdzono istotnych różnic między zastosowanymi metodami w zależności od wieku, płci, miejsca wystąpienia ropniaka, gorączki i pojawienia się przetoki oskrzelowo-opłucnowej. Zarówno LOS, jak i DCTD były krótsze w przypadku pacjentów z grupy TPT, jednakże różnica ta nie była istotna statystycznie. Wnioski: Mimo że różnice nie są wielkie, metoda TPT używana do usuwania zaawansowanego ropniaka u dzieci wydaje się bardziej efektywna pod względem LOS, DCTD oraz ryzyka wystąpienia przetoki oskrzelowo-opłucnowej. Słowa kluczowe: ropniak, metoda jednoportowa, metoda dwuportowa. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (2) 130 THORACIC SURGERY AbstractIntroduction: The differences between single-port (SPT) and two-port techniques (TPT) for the debridement of advanced thoracic empyema in children were evaluated. Material and methods: Age, gender, physical findings, type of thoracoscopic intervention, the length of stay (LOS) and the duration of chest tube drainage (DCTD) were reviewed in 51 patients with thoracic empyema (33 M, 18 F). The SPT was used in 14 patients, while the TPT was used in 37 patients. In the SPT, the telescope itself was used as a dissecting tool. No other instrument was inserted during the debridement. In the TPT, the first port is made for the telescope and the second port for the surgical instrument. A chest tube is inserted through the port site. Results: The empyema was located in the right hemithorax in 24 patients and in the left hemithorax in 25 patients. Two patients suffered from bilateral involvement. The chest tube was removed after a median of 13 days in the SPT and 11 days in the TPT patients. The LOS was a median of 20 days and 13 days in p...

show abstract

Early definitive intervention by thoracoscopy in pediatric empyema

Cited by 74 publications

References 6 publications

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

Abordagem cirúrgica da efusão pleural parapneumônica e suas complicações

THORACIC SURGERY Which technique is the best for the surgical management of empyema thoracis in children?

Contact Info

Product

Resources

About