Question 1 What is the best treatment option for empyema requiring drainage in children?

Course, Christopher William; Hanks, Ruth; Doull, Iolo

doi:10.1136/archdischild-2017-312938

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…These benefits appear greater with the use of small-bore compared to large-bore chest drains [ 8 , 13 ], and possibly with early intervention [ 14 ]. There is debate over the relative benefits of chest drain insertion with the instillation of fibrinolytics or video-assisted thoracoscopic surgery [ 3 , 15 ], and individual patient management is often dependent upon local practices, physician preference and availability.…”

Section: Discussionmentioning

confidence: 99%

“…Although antibiotics alone may suffice in some patients, those with large or more complicated effusions and those not responding to medical management frequently require drainage. The optimal treatment is contentious, but there is agreement that either chest tube drainage with intrapleural fibrinolytics or video-assisted thoracoscopic surgery are the treatments of choice [ 3 ]. There is a wealth of literature on adults, and more recently a number of randomized controlled trials in children, demonstrating both options to be safe and successful, with little outcome advantage of one procedure over another [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

et al. 2018

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BackgroundChest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.ObjectiveTo evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital.Materials and methodsThis was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre.ResultsThree hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery.ConclusionOur technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

et al. 2018

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“…The use of intrapleural thrombolytics in certain patients has been stated by many authors despite the controversies about many aspects. [4][5][6] In spite of the breakthrough in antibiotics therapy in the latest era, parapneumonic effusion and pleural empyema are still a frequent clinical problem that may cause significant mortality and morbidity. The well-established treatment for parapneumonic effusions is drainage by closed system tube drainage and systemic antibiotics.…”

Section: Introductionmentioning

confidence: 99%

“…5,7,8 Despite many studies describing outcomes of intrapleural thrombolytics in pediatric empyema thoracis, the current literature is still deficient in randomized control trials about this subject, which has led to controversial evidence in support for the use of this approach. [5][6][7][8] In this article, we discuss our 10 years of experience in the outcome of using intrapleural thrombolytics for pediatric patients with thoracic empyema.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Thoracic Empyema—Outcomes of Intrapleural Thrombolytics: Ten Years of Experience

Baram

Yaldo

2020

Global Pediatric Health

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Introduction. Pediatric thoracic empyema is a special entity with increasing frequency. Consensus regarding the best management strategy is still evolving. We describe our single-center 10-year experience adopting intrapleural thrombolytics using tissue plasminogen activator as first-line treatment following failure of simple thoracostomy drainage techniques. Methods. Observational prospective study included all children from 1 day to 18 years admitted for parapneumonic effusion and treated with intrapleural thrombolytics. Results. From January 2008 to December 2018, 95 patients were treated by intrapleural thrombolytics for different stages of empyema thoracis. Number of thrombolytic doses required is 2.1 (range = 1-3), and mean amount of drainage is 1050 mL (range = 400-2500 mL). Mean total days of hospitalization is 7.3 days. Complete re-expansion was the primary outcome in 94 patients (98.9%). Conclusion. Intrapleural thrombolytics in complicated pediatric thoracic empyema results in excellent outcome and should be encouraged particularly in limited resource countries.

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When should parapneumonic pleural effusions be drained in children?

Fischer

Mocelin

Andrade

et al. 2018

Paediatric Respiratory Reviews

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Question 1 What is the best treatment option for empyema requiring drainage in children?

Cited by 5 publications

References 11 publications

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children – 16-year, single-centre experience of radiologically placed drains

Pediatric Thoracic Empyema—Outcomes of Intrapleural Thrombolytics: Ten Years of Experience

When should parapneumonic pleural effusions be drained in children?

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