‘Less may be best’—Pediatric parapneumonic effusion and empyema management: Lessons from a UK center

Long, Anna‐May; Smith-Williams, Jonathan; Mayell, Sarah; Couriel, Jon; Jones, Matthew O.; Losty, Paul D.

doi:10.1016/j.jpedsurg.2015.07.022

Cited by 29 publications

(23 citation statements)

References 18 publications

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“…We defined success as not requiring either another drain or surgical intervention, and our success rate of 93% (arguably 94% if we exclude those who needed a second drain for contralateral effusions) compares favourably with previous studies that report between 83% and 93% success [4–6, 19]. Similarly, our mean length of stay at 9.0 days (even after including those with significant pre-morbid medical problems) is very similar to that in previous reports [4–6].…”

Section: Discussionsupporting

confidence: 71%

“…Thoracotomy is now rarely used as a primary treatment – in a recent United Kingdom survey [19], only 2% of patients underwent primary thoracotomy -- and is usually reserved as a rescue treatment. In our series, only four children (1.4%) proceeded to thoracotomy, all after the failure of drain insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Loculations/septations and increased echogenicity within the collection correlate moderately with purulence, but even anechoic effusions may contain frank pus. Overall, no reliable clinical, radiologic or pleural fluid characteristic can determine outcome, the only factor reported to be predictive for failure being necrotising pneumonia identified on initial imaging [19, 20]. Although US cannot reliably establish the stage of collection, it can estimate the effusion size and echogenicity, whether fluid is free or loculated, assess pleural thickening and guide the best site for drainage [11].…”

Section: Discussionmentioning

confidence: 99%

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Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

et al. 2018

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BackgroundChest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.ObjectiveTo evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital.Materials and methodsThis was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre.ResultsThree hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery.ConclusionOur technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

et al. 2018

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“…Pleural empyema rarely complicates community acquired pneumonia, but its incidence seems to have increased in children [3]. Despite the advances in antibiotic therapy during the last decades, thoracic empyema remains a common clinical entity with high mortality (6% -24%) due to delay in initiation of proper treatment [1].…”

Section: Introductionmentioning

confidence: 99%

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Togo¹,

Ouattara²,

Sangaré³

et al. 2015

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Background: Drainage by chest tube thoracostomy is widely used in treatment of early empyema thoracis in children, but drainage with antiseptic lavage-irrigation is more frequent in our context since the last 20 years. This study was to determine which was more effective in our experience comparing chest tube drainage with catheter antiseptic lavage-irrigation versus drainage by chest tube thoracostomy alone in the management of empyema thoracis in children. S. Togo et al. 542situ, less cost and better outcome of stage 2 empyema diseases than a treatment strategy that utilizes chest tube thoracostomy alone.

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“…Intrapleural fibrinolysis should be considered cautiously in patients with NP since the breakdown of fibrinous sealing reaction may favor air leak from necrotic peripheral areas of the lung . In a UK survey of 239 children with parapneumonic effusion, the only factor predictive of failure of fibrinolytic therapy and the need for surgery was the suspicion of NP on initial imaging . Lung surgery is rarely necessary and should be reserved to particularly severe BPF or large pneumatoceles resistant to conservative treatment …”

mentioning

confidence: 99%

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

Benedictis

Carloni²

2019

Pediatric Pulmonology

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‘Less may be best’—Pediatric parapneumonic effusion and empyema management: Lessons from a UK center

Cited by 29 publications

References 18 publications

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

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