Immediate Drainage Is Not Required for All Patients with Complicated Parapneumonic Effusions

Berger, Herbert A.; Morganroth, Melvin L.

doi:10.1378/chest.97.3.731

Cited by 88 publications

(49 citation statements)

References 14 publications

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“…(8) The decision to perform a surgical intervention is controversial, since there is no consensus regarding the role of conservative treatment versus surgical treatment. Many studies indicate that surgical treatment is rarely necessary, (11)(12)(13) whereas others show the benefits of early decortication or debridement of the infected pleura. (14)(15)(16)(17) A systematic review of 67 studies, between 1981 and 2004, comparing conservative treatment (antibiotics and chest tube drainage of the pleural effusion) with surgical treatment, revealed that 76% of all patients evolved satisfactorily when receiving the former.…”

Section: Resultsmentioning

confidence: 99%

Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

et al. 2008

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Objective: To evaluate the results of thoracoscopy for the treatment of pleural empyema in pediatric patients. Methods: A retrospective study of 117 patients who underwent mediastinoscopy or video-assisted thoracoscopy for pleural empyema treatment. General anesthesia and single-lumen oral intubation were used. Surgery was indicated when there was pleural effusion and no clinical and radiological response to clinical treatment (antibiotics, physiotherapy and thoracocentesis) or severe sepsis, together with loculated pleural effusion (confirmed through ultrasound or computed tomography of the chest). Results: Between February of 1983 and July of 2006, 117 thoracoscopies were performed in patients ranging in age from 5 months to 17 years (mean, 4 years). Mean time for thoracic drainage was 9 days (range, 2-33 days), and mean period of hospitalization was 16.4 days (range, 4 to 49 days). One patient (0.8%) died after surgery, and persistent fistula was observed in 33 patients (28%). In 7 cases (6%), open thoracotomy with pulmonary decortication was performed due to the disposition of the empyema. Conclusions: Management of pleural empyema in this age bracket is still controversial, and surgical indication is often delayed, particularly when there are multiple loculations or severe sepsis. Early thoracoscopy yields a better clinical outcome for pediatric patients with pleural empyema, with apparent decreased morbidity and mortality, earlier chest tube removal, earlier hospital discharge and improved response to antibiotic therapy.Keywords: Empyema, pleural; Pediatrics/instrumentation; Thoracoscopy; Thoracic surgery, video-assisted. ResumoObjetivo: Apresentar resultados obtidos com a toracoscopia no tratamento do empiema pleural em pacientes pediátricos. Métodos: Foram avaliados 117 empiemas pleurais, utilizando-se o mediastinoscópio ou a videotoracoscopia, com anestesia geral e sonda de intubação simples. As indicações para a intervenção cirúrgica foram: derrame pleural com ausência de resposta clínica e radiológica ao tratamento clínico (antibióticos, fisioterapia e toracocentese) ou sepse grave, e derrame pleural loculado (documentado por ultrassonografia ou tomografia computadorizada do tórax). Resultados: De fevereiro de 1983 a julho de 2006, 117 toracoscopias foram realizadas em pacientes com idade entre 5 meses e 17 anos (média, 4 anos). O tempo médio de permanência do dreno torácico foi de 9 dias (2 a 33), e o tempo de internação hospitalar foi de 16,44 dias (4 a 49). Houve apenas um óbito (0,8%), e 33 pacientes (28%) tiveram como complicação fístula aérea prolongada. Em 7 pacientes (6%), houve necessidade de conversão para toracotomia com decorticação pulmonar em decorrência da organização do empiema. Conclusão: Não existe consenso para o tratamento do empiema pleural nesta faixa etária. A terapêutica cirúrgica é geralmente requisitada tardiamente no curso da doença, particularmente quando já existem múltiplas loculações ou quadro séptico grave. A toracoscopia indicada mais precocemente no tratamento...

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Section: Resultsmentioning

confidence: 99%

Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

et al. 2008

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“…Though antibiotic therapy alone may be sufficient in certain cases, it remains to be ascertained whether early fluid drainage of complicated effusions has better outcomes compared to conservative therapy alone in such cases (28,29 …”

Section: Management Of Parapneumonic Effusionsmentioning

confidence: 99%

A review of the management of complex para-pneumonic effusion in adults

Koppurapu¹,

Meena²

2017

J. Thorac. Dis.

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A complex para-pneumonic effusion is a descriptive term for exudative effusions, which complicate or are likely to complicate the anatomy of the pleural space after pneumonia. We performed an online search was performed using the resources PubMed and Google Scholar to provide an update on the management of such effusions based on review of published literature. Search terms including pleural effusion (PE), parapneumonic effusion, and empyema were used. Relevant studies were identified and original articles were studied, compared and summarized. References in these articles were examined for relevance and included where appropriate. Studies involving pediatric patients were excluded. Management of para-pneumonic PE has changed tremendously over the last decade. As we accumulate more evidence in this area, approach to pleural fluid drainage is becoming more specific and guideline based. An example of a practice changing study in this aspect is the Multi-center Intrapleural Streptokinase Trial (MIST) 2 trial which demonstrated that a combination of intra-pleural tPA and DNAse improved outcomes in pleural infections compared to DNase or t-PA alone. More randomized control trials are needed to describe the role of surgical techniques like VATS (video-assisted thoracoscopic surgery) when MIST 2 protocol fails; this combination has revolutionized the management of empyema in recently.

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“…Finally, in contrast with lung infection [18], delay in adequate antimicrobial therapy in PF may not be the point [17], as chest tube drainage is an effective treatment to quickly decrease bacterial load and improve the patients' condition [19][20][21]. However, some authors recommend not draining every complicated pleural effusion [22]. Accordingly, although ICU patients aforementioned had small bore pleural pigtail catheter, their need for chest tube drainage, intra-pleural fibrinolysis and thoracic surgery was particularly low (9%, 4% and 4% respectively), rendering the characteristics of the pleural infection and its management different from ours.…”

Section: Microbiology Antibiotics and Prognosismentioning

confidence: 99%

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

Annonay¹

2015

J Pulm Respir Med

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Immediate Drainage Is Not Required for All Patients with Complicated Parapneumonic Effusions

Cited by 88 publications

References 14 publications

Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

A review of the management of complex para-pneumonic effusion in adults

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

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