Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis

Avansino, Jeffrey R.; Sawin, Robert S.; Flum, David R.

doi:10.1542/peds.2004-1405

Cited by 205 publications

(163 citation statements)

References 61 publications

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“…In a meta-analysis of 67 studies done by Avansino et al it was observed that Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs 3.3%), re-intervention rate (2.5% vs 23.5%), length of stay (10.8 vs 20.0 days), duration of tube thoracostomy (4.4 vs 10.6 days), and duration of antibiotic therapy (12.8 vs 21.3 days), compared with patients who underwent non-operative therapy [4]. We found similar findings of aggregate in-hospital mortality rate (0%), re-intervention rate (0%), length of stay (8.26 days), duration of tube thoracostomy (4.53 days) in our study.…”

Section: Discussionmentioning

confidence: 91%

“…4 Incomplete drainage of the pleural space will result in persistent infection which would lead to functional impairment and substantial morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Empyema has classically been divided into 3 stages which follow the progression of their pathogenesis. 3 • 4 This retrospective study is aimed to look at the outcome of empyema after primary operative therapy (VATS).…”

Section: Introductionmentioning

confidence: 99%

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Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

Manasa

Swetha

Yashoda

et al. 2017

Int J Contemp Pediatr

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Background: Empyema thoracis defined as purulent pleural effusion is a common condition in children with significant morbidity and mortality. The aim of therapy for empyema is to ensure rapid recovery with a normal long term pulmonary outcome. VATS (Video-assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. VATS is associated with decreased morbidity and reduced hospital stay of the patient. Methods: This is a retrospective observational study conducted in the department of pediatrics KIMS Hospital, Bengaluru from November 2014 to November 2016. In this study, review of the medical records of all the children aged 2 months to 18 years, who underwent VATS for empyema was done. The children included in the study were diagnosed with empyema thoracis based on chest X- ray, USG chest and CT chest and have undergone VATS by pediatric surgical team. Results: The median age of presentation was 4.1 yrs. 18 children were malnourished of which 3 had severe malnutrition. Male to female ratio was 1:1. Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics. Follow-up data showed that symptoms resolved in 24 children, 2 children had complications, one child had a pneumothorax and another had a broncho-pleural fistula. Results: Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics.Conclusions: These results suggest that primary operative therapy in the form of VATS is an effective treatment option for children with empyema. VATS is associated with a lower in-hospital mortality rate, re-intervention rate, length of stay and duration of tube thoracostomy.

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Section: Discussionmentioning

confidence: 91%

“…4 Incomplete drainage of the pleural space will result in persistent infection which would lead to functional impairment and substantial morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

Manasa

Swetha

Yashoda

et al. 2017

Int J Contemp Pediatr

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“…Meta analysis comparing operative and non-operative procedures has concluded that conservative management leads to recovery in more than 76% of the patients [22]. However, it needs to be emphasised that a less invasive primary operative procedure like drainage with lavage-irrigation has the potential to interrupt the progression of empyema, decrease discomfort associated with prolonged thoracostomy tube usage and reduce the total duration of hospital stay and chest tubes in situ.…”

Section: Discussionmentioning

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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“…This study demonstrated decreased re-intervention rates and time with chest tube in place, shorter duration of antibiotic therapy, shorter length of stay, and decreased inhospital mortality rates with initial operative management [75]. One multicenter study of US children's hospitals compared outcomes for patients treated with a variety of drainage procedures including thoracotomy, chest tube placement with and without fibrinolytics, and videoassisted thoracoscopic surgery (VATS).…”

Section: Treatment Of Complicated Diseasementioning

confidence: 97%

Management of Community-Acquired Pneumonia in Hospitalized Children

Simon

Parikh

Williams

et al. 2015

Curr Treat Options Peds

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Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis

Cited by 205 publications

References 61 publications

Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

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

Management of Community-Acquired Pneumonia in Hospitalized Children

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