Complicated pleural infection: Analysis of two consecutive cohorts managed with a different policy

Moral, Luis; Loeda, C.; Gómez, Francisco Ruíz; Pena, M. A.; Martínez, M.; Cerdán, J; Lillo, L.; Toral, Teresa

doi:10.1016/j.anpede.2015.02.001

Cited by 3 publications

(6 citation statements)

References 27 publications

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“…Although it is often interpreted as a sign of treatment failure, it may also be due to underlying inflammation, prompting the addition of corticosteroids to the treatment. 10,11 In conclusion, this study adds weight to others [6][7][8]12 suggesting that restricting the use of pleural drainage is safe and does not prolong LOS, which may be more conditioned by the routines at each center.…”

Section: Discussionmentioning

confidence: 70%

“…[1][2][3] Although fibrinolytics are considered to have similar efficacy to video-assisted thoracoscopic surgery, 4,5 it is unknown when a drainage procedure for PPE/PE is beneficial, and many patients recover satisfactorily with antibiotic treatment alone. [6][7][8] Because of the potential severity and possible need for interventional procedures, pediatric patients with PPE/PE are often transferred to tertiary referral centers for treatment. The two hospitals…”

mentioning

confidence: 99%

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Management of parapneumonic pleural effusion and empyema in children: A tale of two cities

Moral

Reyes

Toral

et al. 2022

Pediatric Pulmonology

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To the Editor, The management of parapneumonic pleural effusion and pleural empyema (PPE/PE) is controversial. [1][2][3] Although fibrinolytics are considered to have similar efficacy to video-assisted thoracoscopic surgery, 4,5 it is unknown when a drainage procedure for PPE/PE is beneficial, and many patients recover satisfactorily with antibiotic treatment alone. [6][7][8] Because of the potential severity and possible need for interventional procedures, pediatric patients with PPE/PE are often transferred to tertiary referral centers for treatment. The two hospitals

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Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

Management of parapneumonic pleural effusion and empyema in children: A tale of two cities

Moral

Reyes

Toral

et al. 2022

Pediatric Pulmonology

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“…Before 2010, more than 80% of patients with CE/E underwent CTPD in our center; this percentage markedly decreased after changing the initial approach to treatment, without significant changes in the outcomes, especially in the LHS (9). As a result, most CE/E are being treated only with antibiotics.…”

Section: Discussionmentioning

confidence: 96%

“…The decision to use CTPD was personalized according to practicing physicians' (non-standardized) clinical criteria (e.g., persistent septic appearance, marked respiratory distress) rather than the radiological criteria used previously (size and complexity of effusion). As a result, draining of CE/E cases dropped from 83% in the period 2005-2009 to 47% in 2010-2013, without significant differences in outcomes, including LHS (9). After 9 years we wanted to review the treatments and outcomes of our patients, but more than 70% of them came from the eight community hospitals (CH) to which we serve as a reference.…”

Section: Introductionmentioning

confidence: 99%

Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage

et al. 2021

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Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721).Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.

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“…Clinical trials have shown equivalence between pleural drainage with fibrinolysis and VATS, but no trial has compared conservative (only antibiotics) versus invasive management for empyema and complicated pleural effusions. Despite antibiotic treatment alone is generally not recommended in current guidelines, some reports have observed that this approach is suitable for some patients …”

Section: To the Editormentioning

confidence: 99%

Lack of concordance in parapneumonic effusion management in Central European children: Spain is not different

et al. 2016

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Complicated pleural infection: Analysis of two consecutive cohorts managed with a different policy

Cited by 3 publications

References 27 publications

Management of parapneumonic pleural effusion and empyema in children: A tale of two cities

Management of parapneumonic pleural effusion and empyema in children: A tale of two cities

Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage

Lack of concordance in parapneumonic effusion management in Central European children: Spain is not different

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