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Management of parapneumonic collections in infants and children
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Insights
Primary video-assisted thoracoscopic surgery (VATS) significantly reduces procedures, chest tube duration, and hospital stay for children with parapneumonic effusions, offering a valuable treatment approach.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema thoracis is a significant pediatric condition.
- Video-assisted thoracoscopic surgery (VATS) is an established treatment modality.
Purpose of the Study:
- To evaluate the efficacy of initial VATS as a primary treatment for parapneumonic collections in children.
- To compare primary VATS with traditional management strategies.
Main Methods:
- Retrospective review of 139 children with parapneumonic collections (1992-1998).
- Comparison of three management strategies: M1 (delayed thoracotomy), M2 (delayed VATS), and M3 (primary VATS).
- Statistical analysis using Kruskal-Wallis test (P<.05).
Main Results:
- Primary VATS (M3) resulted in a significantly shorter length of stay (7 days) compared to M1 (12 days) and M2 (11 days).
- M3 required significantly fewer procedures (median 1) and shorter chest tube drainage (median 3 days) than M1 and M2.
- No thoracotomies were required in the primary VATS group, unlike M1 (9) and M2 (3).
Conclusions:
- Primary VATS significantly decreases the number of procedures, duration of chest tube drainage, and length of hospital stay in children with parapneumonic effusions.
- Initial VATS is a valuable and effective management strategy for bacterial pneumonia with effusion in pediatric patients.
Background/Purpose:
Video-assisted thoracoscopic surgery (VATS) has a recognized role in treatment of empyema thoracis. The purpose of this report is to show the value of initial VATS as the primary treatment of parapneumonic collections.
Methods:
A retrospective review was done of 139 children who required surgical consultation for parapneumonic collections between January 1992 and July 1998. Management options were (M1) thoracentesis, chest tube drainage, or fibrinolytic therapy and delayed thoracotomy for unresolved collections; (M2) thoracentesis, chest tube drainage, fibrinolytic therapy with delayed VATS if the child remained ill; or (M3) primary VATS. Comparative data included age, duration of prehospital illness, oxygen requirements, white blood cell count, bacterial culture results, number of procedures performed per patient, duration of chest tube drainage, complications, and length of stay. Kruskal-Wallis 1-way analysis was used, with significance at P less than .05.
Results:
A total of 60 children were treated by M1, 38 by M2, and 41 by M3. Age, duration of prehospital illness, oxygen requirements, white blood cell count, bacterial culture results, and complication rates were comparable. The median length of stay was 12 days for M1, 11 days for M2, and 7 days for M3, with M3 significantly shorter at P<.001. The number of procedures was a median of 2 in M1, 2 in M2, and 1 in M3, with M3 significantly fewer at P<.001. Duration of chest tube drainage was a median 5 days for M1 and 3 days for M2 and M3, with M1 significantly longer at P<.001. There were 9 thoracotomies in the M1 group, 3 in the M2 group, and none in the M3 group. One child in M3 required a second VATS.
Conclusions:
Primary VATS has significantly decreased the number of procedures, duration of chest tube drainage and length of stay for children with parapneumonic effusions. Primary VATS appears to be of value in management of bacterial pneumonia with effusion.
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