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Early decortication for postpneumonic empyema in children. Effect on pulmonary perfusion
1Department of Thoracic and Cardiovascular Surgery, Dicle University, School of Medicine, Diyarbakir, Turkey.
Insights
Early pulmonary decortication significantly improves lung function and reduces hospital stays in children with postpneumonic empyema compared to conventional treatment.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonology
Background:
- Postpneumonic empyema is a serious complication in children.
- Delayed treatment can lead to persistent lung issues and prolonged hospitalization.
Purpose of the Study:
- To evaluate the efficacy of early pulmonary decortication in pediatric patients with postpneumonic empyema.
- To compare outcomes of early decortication versus conventional management.
Main Methods:
- A cohort of 137 children with postpneumonic empyema was studied.
- 66 children underwent early pulmonary decortication, while 71 received conventional treatment (intercostal tube drainage, antibiotics, pleural irrigation).
- Pulmonary perfusion was assessed using scintigraphy before and after surgery in a subset of patients.
Main Results:
- Early decortication significantly improved pulmonary perfusion, reducing defects from 57% to 4% (p < 0.001).
- Hospital stay was markedly shorter for the decortication group (19.5 days) compared to the conventional group (73.6 days) (p < 0.001).
Conclusions:
- Early pulmonary decortication is a beneficial surgical intervention for children with postpneumonic empyema.
- This approach leads to improved lung function and reduced healthcare resource utilization.
Abstract:
Early pulmonary decortication was performed on 66 of 137 children with postpneumonic empyema, while 71 received conventional treatment. The mean age of the 66 patients with decortication was 5.5 years (range 6 months-14 years). The empyema was left-sided in 34 and right-sided in 32. Decortication was performed when lung expansion was not obtained after 10-12 days of intercostal tube drainage, antibiotic therapy (guided by sensitivity tests of pleural fluid) and pleural irrigation. Scintigraphy showed loss of pulmonary perfusion on the side of empyema to be 65% +/- SD 20 (25-98)% before decortication in the 23 tested patients. In ten of them the test was repeated after surgery and showed significant (p < 0.001) diminution of the perfusion defect, from 57 +/- 6.8 (25-84)% to 4 +/- 2.6 (0-8)%. The hospital stay was significantly (p < 0.001) shorter for the surgically treated than for the classically managed patients, viz. 19.5 +/- 4 (13-36) days vs 73.6 +/- 14 (34-110) days. Early decortication thus had beneficial effects on pulmonary perfusion and hospital stay.