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

Togo, Seydou; Ouattara, M.; Sangaré, Ibrahim; Saye, Jacque; Touré, Cheik Amed Sekou; Maiga, Ibrahim Boubacar; Dakouo, D.; Guo, Liang; Koumaré, S; Koita, Adama K.; Sanogo, Zimogo Zié; Yena, Sadio

doi:10.4236/ss.2015.612077

Cited by 4 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…97 Antiseptic irrigation has also reportedly been used in the management of acute pediatric empyema. 98 Whether pleural irrigation with antiseptic solution can improve outcomes in adult acute pleural infection is another intervention to be explored in future research. Repeated Pleural Aspiration.…”

Section: Surgical Interventionmentioning

confidence: 99%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

View full text Add to dashboard Cite

Pleural infection in adults has considerable morbidity and continues to be a lifethreatening condition. The term "pleural infection" encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Management of pleural infection requires prolonged duration of hospitalization (average 14 days). There are recognized differences in microbial etiology of pleural infection depending on whether the infection was acquired in the community or in a health-care setting. Anaerobic bacteria are acknowledged as a major cause of pleural infection, and thus anaerobic coverage in antibiotic regimens for pleural infection is mandatory. The key components of managing pleural infection are appropriate antimicrobial therapy and chest-tube drainage. In patients who fail medical therapy by manifesting persistent sepsis despite standard measures, surgical intervention to clear the infected space or intrapleural fibrinolytic therapy (in poor surgical candidates) are recommended. Recent studies have explored the role of early intrapleural fibrinolytics or first-line surgery, but due to considerable costs of such interventions and the lack of convincing evidence of improved outcomes with early use, early intervention cannot be recommended, and further evidence is awaited from ongoing studies. Other areas of research include the role of routine molecular testing of infected pleural fluid in improving the rate of identification of causative organisms. Other research topics include the benefit of such interventions as medical thoracoscopy, high-volume pleural irrigation with saline/antiseptic solution, and repeated thoracentesis (as opposed to chest-tube drainage) in reducing morbidity and improving outcomes of pleural infection. This review summarizes current knowledge and practice in managing pleural infection and future research directions.

show abstract

Section: Surgical Interventionmentioning

confidence: 99%

Recent Insights into the Management of Pleural Infection

Hassan

Patel

Sadaka

et al. 2021

IJGM

View full text Add to dashboard Cite

show abstract

“…While initial broad-spectrum antibiotics should cover the typical bacterial flora of the underlying disease, it is adapted to the results of the bacterial culture of the pleural samples later on [ 19 ]. However, cultures are slow and can have false-negative results because of small sample volume, previous antibiotic therapy, or unsatisfactory conditions of transport and storage which can impair the viability of pathogens [ 24 ]. This was evident in multiple studies with low yield of pleural fluid culture.…”

Section: Discussionmentioning

confidence: 99%

Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics

Diez

Perez

Malayan

et al. 2020

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

Empyema thoracis, defined as the accumulation of pus in the pleural space, is a rare entity in the neonatal period. There are very few cases described in the medical literature and there are still no treatment protocols in the management of empyema in neonates. In older infants and children, intrapleural fibrinolytics and surgery are often utilized since treatment of complicated parapneumonic effusions with chest tube and antibiotics alone often fail due to the viscous fluid and presence of loculations. Presented here is a case of a term neonate who exhibited symptoms of respiratory distress on the sixth day of life. Imaging modalities revealed massive left sided pleural effusion with loculations and mass effects. Pleural fluid was grossly pus and exudative in nature. Gram stain revealed gram-positive cocci but culture was negative. Empiric broad-spectrum antibiotics and chest tube drainage were utilized and patient was discharged after forty-seven days of hospital admission. In spite of prolonged hospital stay, patient survived with no complications. Therefore, nonoperative therapy could still be an option for neonates with loculated empyema. The key to success in treatment is immediate identification of effusion, prompt initiation of antibiotics, and early effective chest tube drainage.

show abstract

“…The prime aim of treating ET is to restore the lung function. Several studies concluded that Stage I and II disease can safely be managed by antibiotics and ICD with or without fibrinolysis therapy/antiseptic lavage-irrigation of the chest tube[78] while Stage III and IV disease require surgical intervention. [9] Frank purulent or turbid pleural fluid on needle aspiration signifies early stage (I/II) of the disease which required prompt ICD.…”

Section: Discussionmentioning

confidence: 99%

Empyema thoracis in children: A 5-year experience in a Tertiary Care Institute

Mandal

Halder

et al. 2019

J Indian Assoc Pediatr Surg

View full text Add to dashboard Cite

Objective: Empyema thoracis (ET) in children is a disease of significant morbidity and mortality. In the event of failure to resolute following intercostal chest tube drainage (ICD), thoracotomy decortication (TDC) remains the treatment of choice. We have reviewed the outcome of management of 96 cases of ET with the intent to establish the scope of ICD as primary form of the management. Materials and Methods: This is a retrospective study of 96 patients of ET who were managed in pediatric surgery department over a period of 5 years (April 2013 – March 2018). Ninety-six patients at a single center met inclusion criteria for having ET and underwent ICD. We excluded the cases where video-assisted thoracoscopic surgery was provided as primary treatment. The patients were categorized into complicated and uncomplicated groups. Those with pyopneumothorax, encysted empyema, multiloculated empyema, and bilateral ET were assigned as complicated group. There were two treatment groups: (I) those responded with ICD alone (II) those with ICD followed by TDC. Results: All 96 cases received ICD as primary management. There were 54 uncomplicated cases and 42 complicated cases. Out of 42 complicated cases, 26 patients recovered with ICD alone and 16 patients needed TDC. A total of 80 (83.33%) patients (54 uncomplicated ± 26 complicated) recovered with ICD alone. Significant complications were encountered in follow-up of patients who underwent delayed thoracotomy in the form of overriding of the ribs ( n = 3) and postoperative air leak ( n = 4). There was no mortality in our series. Conclusion: Early initiation of management of ET with intercostal tube drainage is simple, safe, effective even in complicated cases, and has less complications. Thoracotomy with decortication should be reserved for ICD failure cases.

show abstract

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

Cited by 4 publications

References 20 publications

Recent Insights into the Management of Pleural Infection

Recent Insights into the Management of Pleural Infection

Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics

Empyema thoracis in children: A 5-year experience in a Tertiary Care Institute

Contact Info

Product

Resources

About