Thoracoscopy in stage 3 empyema thoracis in children – A safe and feasible alternative to thoracotomy

Santanakrishnan, Ramesh; Murali, Govindappa Saroja; Deepak, J; Shankar, Gowri; Babu, Narendra; Jadhav, Vinay

doi:10.1016/j.jpedsurg.2019.08.007

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…However, the included patients in our study had a much longer course of the disease and the empyema progressed into the organizing phase in many patients. VATS has been used for some of Stage 3 empyema, 56 but we still chose thoracotomy if the patient had a pleural peel with high thickness and calcification, extensive lung necrosis, or bronchopleural fistula.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

Yang

Chen

et al. 2021

Pediatric Pulmonology

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Introduction Tuberculous empyema (TE) in children is common in high‐TB burden and medical resource‐limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. Methods We performed a retrospective study of children with empyema secondary to community‐acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non‐tuberculosis infection (non‐tuberculosis empyema, NTE). Results One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest‐tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. Conclusion Tuberculosis infection should be screened in management of children with empyema in high‐TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource‐limited area.

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Section: Discussionmentioning

confidence: 99%

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

Yang

Chen

et al. 2021

Pediatric Pulmonology

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“…The number of chest X-rays was lower for children with corticosteroids than for those without (median [IQR] 2 [2][3][4] versus 4 [2-6], p = .01), while the number of chest ultrasounds and chest computed tomography scans did not differ between the two groups.…”

Section: Medical Imagingmentioning

confidence: 99%

“…3 It can be divided into three stages: inflammatory exudate, clear in appearance, sterile (Stage I); purulent exudate resulting from translocation of white blood cells into the fluid with deposition of fibrin in the pleural space (Stage II); organized empyema with formation of a thick membrane covering the visceral pleura (Stage III). 4,5 The management of parapneumonic effusions remains an area of controversy, and various therapeutic options are described. [6][7][8] If conservative treatment with antibiotics alone is a reasonable option for small parapneumonic effusions, guidelines recommend evacuation of effusions which are enlarging (>2 cm), compromising respiratory function and/or associated with loculations; intrapleural fibrinolysis is usually suggested for effusions of thick fluid with loculations or empyema; and surgery (videoassisted thoracoscopic surgery [VATS], or less frequently thoracotomy with decortication) is recommended in case of failure of treatment by antibiotics, chest tube drainage, and/or fibrinolytics.…”

Section: Introductionmentioning

confidence: 99%

“…Chest tube insertion and intrapleural fibrinolysis occurred less frequently in children about to receive corticosteroids (chest tube 61.8% vs. 81.0%, p = .041; intrapleural fibrinolysis 25.5% vs. 42.9%, p = .07). The duration of chest drainage did not differ between children with and those without corticosteroids (median [IQR] 5[3-8.25] vs. 5(3)(4)(5)(6), p = .184). The total volume evacuated through the chest tube tended to be higher in children without corticosteroids (median [IQR] 480 [300-805] ml vs. 390 (137-579) ml), this discrepancy almost reaching the statistical significance threshold (p = .07).…”

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confidence: 99%

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Management of parapneumonic pleural effusion in children: Is there a role for corticosteroids when conventional nonsurgical management fails? A single‐center 15‐year experience

Thimmesch

Mulder

Lebrun

et al. 2021

Pediatric Pulmonology

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Objective: Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children.Methods: Retrospective single-center observational study of all children hospitalized with a diagnosis of parapneumonic pleural effusion during a 15-year period.Results: We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range [IQR]) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children had been febrile for 9 (IQR: 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only one patient required a video-assisted thoracoscopy that was necessary for morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and those without corticosteroids. Conclusion:Our findings indicate that corticosteroids may be a part of the therapeutic armamentarium for children with parapneumonic effusion when conventional nonsurgical management fails.

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“…Parapneumonic effusion complicates up to 13% of cases of hospitalized pneumonia among children 3 . It can be divided into three stages: inflammatory exudate, clear in appearance, sterile (stage I); purulent exudate resulting from translocation of white blood cells into the fluid with deposition of fibrin in the pleural space (stage II); organized empyema with formation of a thick membrane covering the visceral pleura (stage III) 4,5 . The management of parapneumonic effusions remains an area of controversy, and various therapeutic options are described 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Corticosteroids for the management of parapneumonic pleural effusion in children: a 15-year experience

Thimmesch

Lebrun

Pierart

et al. 2021

Preprint

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Objective: Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children. Methods: Retrospective monocenter cohort study of all children hospitalized with a discharge diagnosis of parapneumonic pleural effusion during a 15-year period. Results: We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range (IQR)) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children were febrile since 9 (IQR 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only 1 patient required a video-assisted thoracoscopy that was provided because of morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged alive from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and without corticosteroids. Conclusion: Our results indicate that corticosteroids could be associated with a significant reduction in the use of surgical procedures and with a prompt clinical improvement. Corticosteroids could thus offer a non-invasive therapeutic alternative for children with parapnemonic effusions when antibiotics and pleural drainage are considered a failure.

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Thoracoscopy in stage 3 empyema thoracis in children – A safe and feasible alternative to thoracotomy

Cited by 7 publications

References 20 publications

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

Comparison of pediatric empyema secondary to tuberculosis or non‐tuberculosis community‐acquired pneumonia in those who underwent surgery in high TB burden areas

Management of parapneumonic pleural effusion in children: Is there a role for corticosteroids when conventional nonsurgical management fails? A single‐center 15‐year experience

Corticosteroids for the management of parapneumonic pleural effusion in children: a 15-year experience

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