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Treatment of pleural empyema
P W Chan1, O Crawford, C Wallis
1Respiratory Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Insights
Pediatric pleural empyema management involves antibiotics and chest tube drainage. Surgical intervention is reserved for cases with inadequate early treatment, leading to full recovery in most children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pleural empyema is a significant pediatric respiratory infection.
- Prompt diagnosis and management are crucial for favorable outcomes.
Purpose of the Study:
- To outline the clinical presentation of pediatric pleural empyema.
- To evaluate treatment strategies and their effectiveness in children.
Main Methods:
- Retrospective review of medical and radiological records.
- Analysis of data from 54 pediatric patients admitted between 1989 and 1997.
Main Results:
- Common symptoms included fever (98%), cough (83%), and chest pain (38%).
- Intravenous antibiotics and closed chest tube drainage were primary treatments (87%).
- Decortication was performed in 39% of patients with unsatisfactory response.
Conclusions:
- Intensive medical management with chest tube drainage and antibiotics ensures resolution for most pediatric cases.
- Surgical intervention is vital for patients not responding to early medical treatment.
Objective:
To determine the clinical presentation and treatment strategies for children admitted with pleural empyema.
Methodology:
Retrospective review of medical and radiological records of 54 patients admitted with pleural empyema between January 1989 and April 1997.
Results:
Fever (98%), cough (83%), chest pain (38%), clinical cyanosis (17%) and abdominal pain (16%) were common clinical features. The causative organism was identified in 17 patients (31%). Intravenous antibiotics were given for a mean of 18. 2 +/- 7.5 days. Forty-seven (87%) patients had closed chest tube drainage and 21(39%) patients underwent decortication for unsatisfactory response to medical treatment. The chest tube insertion was more likely to be delayed in patients who required decortication, although the difference was not significant (8.1 +/- 5.4 vs 6.3 +/- 5.2 days of illness, P = 0.67). All patients were discharged well, with almost complete resolution of the chest radiograph at 6 months.
Conclusions:
Intensive medical management with adequate chest tube drainage and appropriate antibiotics will result in full resolution for most patients. Surgical intervention is important in patients who fail to receive adequate treatment early in the disease.