Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors

Kalfa, Nicolas; Allal, H.; López, Manuel; Saguintaah, M.; Guibal, Michel; Sabatier-Laval, Edith; Forgues, D.; Counil, F.; Galifer, R B

doi:10.1016/j.jpedsurg.2006.05.066

Cited by 40 publications

(46 citation statements)

References 29 publications

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“…Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study Although thoracoscopy is currently the procedure of choice for children with complicated parapneumonic pleural effusion at the fibrinopurulent stage, (9)(10)(11) there have been no well-designed studies involving a significant number of patients and assessing the true effectiveness of this method in the management of complicated parapneumonic pleural effusion in children. (12,13) The objective of this multi-institutional study was to determine the efficacy of thoracoscopy in the management of a significant number of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage.…”

Section: Original Articlementioning

confidence: 99%

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

2009

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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...

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Section: Original Articlementioning

confidence: 99%

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

2009

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“…Usually clinical findings are fever (60-86% of patients), chest pain (60%), dyspnea (47-74%), cough (31%), sputum production, poor appetite, weight loss (1,6,8). In our patients the main symptoms were fever, chest pain, dyspnea and cough.…”

Section: Discussionmentioning

confidence: 59%

“…Because of a higher rate of conversion to open thoracotomy and technical difficulties during the surgery, VATS empyemectomy would clearly show better results when applied at the appropriate time. The timing of surgery is very important because it is expected to be a major prognostic factor in postoperative outcomes (8,26). Unfortunately, there is a lack of data regarding the optimal timing of surgical intervention, so there is no consensus regarding this issue.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, open thoracotomy represented the main stay of treatment for this condition, but recently numerous attempts have been performed to replace it by a minimally invasive approach (2,(5)(6)(7). The precise role of video-assisted thoracic surgery (VATS) in the management of pleural empyema remains controversial and no consensus is currently in place on which surgical option and for what the patient is the first line (8)(9)(10). Some recent studies suggest that VATS and open thoracotomy are showing similar treatment success rates and are equally effective.…”

Section: Introductionmentioning

confidence: 99%

“…Some recent studies suggest that VATS and open thoracotomy are showing similar treatment success rates and are equally effective. Successfully done VATS, being less invasive, provides the additional advantages of decreased postoperative discomfort, pain, better cosmetics, higher patient satisfaction and shorter hospitalization time, especially if performed relatively early (5,8,9,11). However, in up to 59% of patients VATS is inadequate and conversion to open thoracotomy is necessary during the same operation (12,13).…”

Section: Introductionmentioning

confidence: 99%

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Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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Background. Empyema remains a challenging entity for thoracic surgeons. The aim of this study was to evaluate preoperative predictors for unsuccessful thoracoscopic empyemectomy and postoperative complications.Materials and methods. There were 71 patients prospectively included in the study during the period from January 2011 to June 2014 in whom we performed thoracoscopic empyemectomy. Two main outcomes were evaluated: conversion and complications. Preoperative factors that could predict these outcomes were analyzed.Results. Conversion to open thoracotomy was required in 25.4% of cases. Fourteen (19.7%) patients had postoperative complications. The multivariate analysis showed that the time of illness (odds ratio 1.1; confidence interval 1.1-1.2), normal temperature on admission (odds ratio 11.2; confidence interval 1.5-85.4) and frank pus found on thoracocentesis (odds ratio 6.9; confidence interval 1.6-29.4) had a significant influence on conversion from thoracoscopy to open thoracotomy. Pain (odds ratio 0.01; confidence interval <0.01-0.6), subfebrile temperature on admission (odds ratio 10.1; confidence interval 1.4-73.5), positive pleural culture (odds ratio 8.5; confidence interval 1.0-70.1), Charlson comorbidity index (odds ratio 2.3; confidence interval 1.1-4.8), empyema volume (odds ratio 1.002; confidence interval 1.000-1.005) and empyema density (odds ratio 0.8; confidence interval 0.6-1.0) had a significant influence on postoperative complications.Conclusions. Longer time of illness, normal temperature on admission and frank pus in pleural aspiration increase probability of conversion. No pain, subfebrile temperature, higher Charlson comorbidity index on admission, positive pleural culture, higher volume and lower density of empyema on computed tomography scan increase probability of postoperative complications.

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Management of parapneumonic effusions in pediatrics: Current practice

McBride

2008

Journal of Hospital Medicine

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Pneumonia with associated complex pleural disease is a cause of significant morbidity among hospitalized children. The management of this patient population continues to be a challenge and varies even among single institutions. The article presented here reviews the management goals for pediatric patients hospitalized with complex parapneumonic effusions and provides updated summaries of both medical and surgical therapies.

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Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors

Cited by 40 publications

References 29 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

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Management of parapneumonic effusions in pediatrics: Current practice

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