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

Freitas, Sergio Luiz Oliveira de; Fraga, José Carlos Soares de; Canani, Fernanda da Silva

doi:10.1590/s1806-37132009000700007

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…Most international studies, although stating that pneumonic complications significantly affect young children, found higher mean age (4-7.6 years), and lower proportion of infants and preschool children than in our study, in which 87% had less than five years. This trend, however, is in agreement with that reported by Brazilian literature, with an average age between two and 2.9 years [4][5][6][7][8][9][10][11] . The prevalence of short stature is higher than the national average (11% vs. 7.2%).…”

Section: Discussionsupporting

confidence: 92%

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Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

Arêas

Júnior

et al. 2016

Rev. Col. Bras. Cir.

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Objective: to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE), and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD) . Methods: we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011. Results: we studied 46 patients, most children under three years of age (74%), with no gender predominance. A significant portion of the sample (28%) had inappropriate body mass index. We found short stature in five patients (11%), which tended, in general, to a worst postoperative outcome when compared with children of normal height (p=0.039). The average duration of symptoms till admission was 16.9 days. Empyema was a common diagnosis in the first surgery (47.8%), and its bearers had longer duration of chest tube drainage (p=0.015). Most children (80.4%) were operated only once. The mean length of hospital stay was 25.9 days. Thoracic drainage (water-sealed) was the most common procedure (85%), with conversion to OTD in 24% of the sample, thoracotomy being rare (4%). There were no deaths. Conclusion: the studied individuals often had advanced disease and nutritional disorders, affecting outcome. OTD remains a valid option for specific situations, and further studies are needed for confirmation.

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Section: Discussionsupporting

confidence: 92%

“…7,17 . In another national study, Freitas et al 8 achieved an even higher rate of cure with only one procedure (88%). In this multi-institutional study, they analyzed cases of PPE in the fibrinopurulent stage, using VATS as the initial approach.…”

Section: Discussionmentioning

confidence: 90%

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

Arêas

Júnior

et al. 2016

Rev. Col. Bras. Cir.

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“…17 A retrospective series of 89 children undergoing primary VATS showed 12% risk of a subsequent procedure to address ongoing disease or a complication. 18 However, such was not the case with the current study, where notably none had recurrence of empyema over a 3 month follow up.…”

Section: Discussioncontrasting

confidence: 72%

Operative management of pediatric empyema: a single center review

Sharma¹,

Sapkota²,

Thapa³

et al. 2018

J. Soc. Surg. Nepal

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Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one. Aim: The aim of this study was to review our experience in pediatric empyema thoracis. Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center. Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality. Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.

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“…There are studies that report the LOS, the duration of chest drainage, the success rate, and the frequency of complications, but with no comparison group regarding the timing of thoracoscopy. 13 - 17 , 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Until the early 1990s, surgical debridement via thoracoscopy was indicated after a period of simple drainage, if there was no clinical improvement. 3 Currently, there is evidence from retrospective studies, 4 - 17 prospective studies, 18 - 20 systematic reviews, 21 - 25 and a meta-analysis 26 in favor of the superiority of thoracoscopy over simple drainage in the treatment of pleural empyema, indicating that thoracoscopy should be performed, especially when ultrasound shows septations or loculations. 27 However, PPE being approached late is still common, there being delay and difficulty in referring such children to referral centers.…”

Section: Introductionmentioning

confidence: 99%

Parapneumonic pleural effusion: early versus late thoracoscopy

Pereira¹,

Alvim

Andrade

et al. 2017

J. bras. pneumol.

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Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications.Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization.Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths.Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

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

Cited by 17 publications

References 24 publications

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

Operative management of pediatric empyema: a single center review

Parapneumonic pleural effusion: early versus late thoracoscopy

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