Related Experiment Videos
Echo-guided management of complicated parapneumonic effusion in children
Chih-Yung Chiu1, Kin-Sun Wong, Yhu-Chering Huang
1Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Insights
Managing parapneumonic effusion in children is challenging. This study shows chest ultrasound can stage effusion severity, guiding treatment. Early intervention with video-assisted thoracic surgery (VATS) improves outcomes for complex cases.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Optimal management of pediatric parapneumonic effusion and empyema lacks clear guidelines due to insufficient evidence.
- Parapneumonic effusion staging is crucial for determining appropriate therapeutic strategies.
Purpose of the Study:
- To characterize biochemical markers of parapneumonic effusion.
- To evaluate the impact of different therapeutic approaches on ultrasound-defined stages of parapneumonic effusion.
Main Methods:
- Chest ultrasound was used to classify parapneumonic effusion into three stages based on fibrin deposition and septation.
- Biochemical analysis of pleural fluid (pH, glucose, protein, LDH) and hemogram (WBC, platelets) were performed.
- Outcomes were compared between initial chest tube drainage and video-assisted thoracic surgery (VATS).
Main Results:
- Advanced ultrasound stages correlated with longer fever duration.
- Pleural fluid pH < 7.27 was the sole significant predictor of fibrin formation.
- Successful tube drainage rates decreased with advanced effusion stages.
- Initial VATS resulted in significantly shorter fever duration and hospital stay compared to chest tube drainage.
Conclusions:
- Chest sonography effectively differentiates progressive stages of bacterial parapneumonic effusion in children.
- Early, aggressive tube drainage may prevent surgery in early-stage effusions.
- Initial VATS is recommended for fibrin-septated parapneumonic effusions to reduce morbidity.
Abstract:
The optimal management of parapneumonic effusion and empyema in children remains controversial; currently there is insufficient evidence to give clear guidance on therapy. The aims of this study were to delineate the biochemical characteristics and to examine the effect of different therapeutic strategies on ultrasound staging of parapneumonic effusion. The ultrasonic appearances were classified according to the deposition of fibrin or formation of fibrin septations. A total of 81 patients were enrolled in the present study. Chest ultrasound was performed and results were stratified into anechoic fluid (stage 1, n = 23), with floating fibrin strands (stage 2, n = 30), and with septated fibrin (stage 3, n = 28). The mean days of fever elapsed before detection of these stages appeared to be higher at advanced stages (7.3 +/- 2.1 vs. 8.5 +/- 2.7 vs. 9.7 +/- 4.2, respectively; P = 0.03). Univariate analysis revealed that WBC, platelet count in hemogram and pH, glucose, protein, LDH in pleural effusion were significantly associated with the stages of parapneumonic effusion. Multivariate logistic analysis revealed that pH (less than 7.27) in pleural fluid was the only significant factor for the formation of fibrin with/without fibrin septations. The rate of successful tube drainage decreased as the advancement of stages of parapneumonic effusion, especially in patients using chest tube for drainage initially (P = 0.001). Total duration of fever and hospital stay was significantly shorter for those children who had initial video-assisted thoracic surgery (VATS) compared to those who had initial chest tube drainage (P < 0.001). Chest sonography can well discriminate the progressive stages of bacterial parapneumonic effusion. In children with a progressive parapneumonic effusion with fibrin formation, early aggressive tube drainage may avoid a subsequent surgical intervention. In children with a fibrin septated parapneumonic effusion, an initial VATS is recommended to shorten the duration of fever and hospital stay.
Related Concept Videos
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia III: Complications and Assessment