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[Management of parapneumonic pleural effusions]
O Asensio de la Cruz1, J Blanco González, A Moreno Galdó
1Servicios de Pediatría Corporació Sanitària Parc Taulí. Sabadell, Barcelona.
Insights
Pediatric pleural effusion, often caused by bacterial pneumonia, requires prompt treatment. Early pleural drainage and interventions like fibrinolytics or thoracoscopic debridement improve outcomes in complicated cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Surgery
Context:
- Pleural effusion frequently complicates childhood pneumonia, affecting up to 40% of hospitalized cases.
- Bacterial pneumonia, particularly Streptococcus pneumoniae infections, is the leading cause of pediatric pleural effusion and empyema.
- Empyema complicates 0.6-2% of pneumonias in children.
Purpose:
- To outline current treatment strategies for pediatric pleural effusion.
- To define indications for early pleural drainage and surgical intervention.
- To review the efficacy of medical and minimally invasive treatments.
Summary:
- Treatment involves early antibiotics, imaging, and interventions such as thoracocentesis and pleural drainage.
- Key indications for early drainage include gross pus, positive Gram stain, low pleural fluid glucose (<50mg/dL), low pH (<7), and sonographic loculations.
- Local fibrinolytics (38-100% success) and thoracoscopic debridement (30-100% success) are effective in specific effusion stages, potentially reducing the need for formal surgery.
Impact:
- Optimized treatment protocols can improve patient outcomes and reduce morbidity associated with pediatric pleural effusion.
- Understanding indications for early intervention guides clinical decision-making in managing complicated pneumonia.
- Minimally invasive techniques offer effective alternatives to traditional surgery for pediatric empyema.
Abstract:
Pleural effusion in children is most often due to bacterial pneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40% of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism. Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100%, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100% of patients, also depending on the effusion stage.