Background

Parapneumonice ffusions should be treated with antibiotic to control the infection of the lung tissue with drainage of the pleural fluid and reexpansion of the affected lung tissue.
In complicated parapneumonic pleural effusions and empyema sometimes the drainage with a chest tube is insufficient so we can use intrapleuralfibrinolytics in order to prevent obstructed chest tube as well as lyse adhesions and therefore facilitate successful drainage.
When chest tube drainage is unsuccessful and patient is not responding to treatment video-assisted thoracoscopic surgery (VATS) and decortication with removal of the pleural peel is providing a less invasive treatment for empyema as thoracotomy.
We believe that an early intervention in managing children with empyema is the key for treatment and it should be in selected cases of complicated effusions done by VATS primarily.

Key words: pediatric parapneumonic effusion, VATS decortications

Materials/methods

A study of 74 children with parapneumonic pleural effusions who were treated at University Medical Centre in Ljubljana at Department of Pediatric Surgery between 2012 and 2016.

Results

In the years between 2012 and 2016 we have treated 74 children with parapneumonic pleural effusion that required intervention, 29 girls and 45 boys aged between 4 months up to 15 years old.

All the patients were treated with an antibiotic for pneumonia and had chest Xray and most of them US of the pleural cavity that confirmed the diagnosis of effusion.

63 children had a chest tube inserted in general anaesthesia on the day of admission on our ward and 7 patients had primary intervention by VATS because of the loculated effusion.

More than half of the patients with chest tube had intrapleuralfibrinolytics, most of them 3 days in row and in 16 patients the infection was controlled only by chest tube drainage and antibiotics.

13 patients had VATS decortication after the insertion of the chest tube so all together we did 20 VATS decortication procedures which were all without complications.

Conclusion

In the last years we are seeing more and more cases of complicated parapneumonic effusions in children that require a surgical intervention in general anaesthesia , in the year 2015 23, this year so far 13.

All the patients have an US done before an intervention for the best results and in cases of thick pleural adhesions we recommend treatment with VATS decortication since there is no more complications that with the insertion of a chest tube.

 

Ana Mavko
University Medical Centre Ljubljana
Department of Thoracic Surgery
Corresponding author's e-mail: amavko@yahoo.com

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