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Conservative use of chest-tube insertion in children with pleural effusion

R Epaud1, G Aubertin, M Larroquet

  • 1Pediatric Pulmonology and INSERM U719, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, 26 avenue Arnold Netter, 75012, Paris, France. ralph.epaud@trs.ap-hop-paris.fr

Pediatric Surgery International
|February 24, 2006
PubMed

Insights

A conservative approach to chest-tube insertion for pediatric pleural infection did not alter patient outcomes. This strategy, reserving drainage for severe cases, reduced chest-tube use without impacting recovery time or hospitalization length.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Thoracic Surgery

Background:

  • Pleural infection, or empyema, is a significant cause of morbidity in children.
  • Traditional management often involves early chest-tube insertion for drainage.
  • The optimal strategy for chest-tube use in pediatric pleural infection requires further evaluation.

Purpose of the Study:

  • To assess the impact of a conservative chest-tube insertion protocol on short- and long-term outcomes in pediatric pleural infection.
  • To compare outcomes between classical and conservative chest-tube management strategies.

Main Methods:

  • A comparative study of 65 pediatric patients (1 month to 16 years) with pleural infection.
  • Patients were randomized into two groups: classical management (chest-tube insertion) and conservative management (drainage only for severe effusions).
  • Outcomes measured included duration of fever, C-reactive protein normalization, hospitalization length, and antibiotic duration.

Main Results:

  • Chest-tube insertion was significantly lower in the conservative group (25%) compared to the classical group (52%).
  • Patients in the conservative group experienced shorter durations of fever and faster C-reactive protein normalization.
  • Hospitalization duration, intravenous antibiotic therapy, and chest radiograph normalization time did not differ significantly between groups.

Conclusions:

  • A conservative approach to chest-tube insertion in pediatric pleural infection is feasible and reduces intervention rates.
  • This strategy does not negatively affect short- or long-term patient outcomes.
  • Chest drainage can be reserved for pediatric patients with severe pleural empyema, mediastinal shift, respiratory distress, or uncontrolled sepsis.

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