Related Experiment Videos
Outcomes of primary image-guided drainage of parapneumonic effusions in children
Ragheed K Mitri1, Stephen D Brown, David Zurakowski
1Division of Cardiovascular and Interventional Radiology, Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Image-guided needle aspiration and percutaneous catheter drainage for pediatric parapneumonic effusions showed similar outcomes, but aspiration alone led to higher reintervention rates, especially with low pH and glucose.
Area of Science:
- Pediatric Pulmonology
- Interventional Radiology
- Thoracic Medicine
Background:
- Parapneumonic effusions are common in children.
- Image-guided drainage is a standard treatment.
- Comparing needle aspiration and catheter drainage is crucial for optimal management.
Purpose of the Study:
- To compare the efficacy of image-guided needle aspiration versus percutaneous catheter drainage for pediatric parapneumonic effusions.
- To identify predictors of reintervention in children with parapneumonic effusions.
Main Methods:
- Retrospective chart review of 67 children with parapneumonic effusions.
- Analysis of medical records, microbiology, and radiology reports.
- Comparison of outcomes between needle aspiration and pigtail catheter placement.
Main Results:
- Both drainage methods had similar lengths of stay and complication rates.
- Reintervention rate was 27%, significantly higher after primary aspiration without catheter.
- Low pH, fluid loculation, and low glucose levels were predictors of reintervention.
Conclusions:
- Image-guided needle aspiration and catheter drainage have comparable complication rates and lengths of stay.
- Primary aspiration without catheter placement increases reintervention risk, particularly in complicated effusions.
- Consider primary catheter placement for pediatric parapneumonic effusions, guided by on-site pH and glucose monitoring.
Objective:
To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children.
Methods:
A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000.
Results:
Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low.
Conclusions:
Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer.