Parapneumonic pleural effusion: early versus late thoracoscopy

Abstract

Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications.Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization.Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths.Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

The role of the RAPID score in surgical planning for empyema

“…Previous studies have examined how the RAPID score and surgical timing, independently, have affected outcomes ( 1 - 3 , 11 , 12 , 15 , 16 ). To our knowledge, ours is the first multicenter study that examines RAPID score in association with surgical timing.…”

“…Early surgery was defined as ≤3 days from diagnosis and late surgery was defined as >3 days. As noted by Touray et al, there is no consensus on the definition of early versus late surgical timing with reported values between 48 hours and 2 weeks in previous literature (3,(11)(12)(13). Also, we chose 3 days to allow for the typical dose regimen of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) as reported in the MIST2 trial (14).…”

Value of Ultrasonography in the Diagnosis of Pleural Effusion: Analysis of 582 Cases

“…The former accounted for 62.4% and the latter 37.6%. Compared with UPPE, CPPE had higher protein, LDH and CRP, but lower glucose and PH [14]. The progress of PPE can be divided into three stages: stage I is the exudative stage, with low content of in ammatory cells and good uidity; stage II is the brous purulent stage, with deposition of brin and brous septum; stage III (tissue organization stage) with brous cell proliferation and pleural thickening [15][16].…”

Momentum

“…In this issue, we publish a quite interesting study evaluating the best “moment” at which to perform thoracoscopy in the approach to parapneumonic effusion in pediatric patients. 12 In addition to the obvious scientific aspect of the information generated by the study, one can understand that there are opportunities for future studies in the area. So what explains the fact that pleural diseases are so poorly represented in our scientific context?…”

“…Neste número publicamos um estudo muito interessante avaliando o melhor momento para a realização de toracoscopia na abordagem do derrame parapneumônico em pediatria. 12 Além do claro aspecto científico da informação gerada pelo estudo, pode-se entender a oportunidade existente na área para futuros estudos. O que justifica, portanto, a baixa representatividade das doenças pleurais em nosso contexto científico?…”