DOI: http://dx.doi.org/10.18203/2349-3933.ijam20185501

Efficacy of early thoracoscopic debridement for syn-pneumonic pleural effusions in pediatric age group

Kiran Grandhi, Prashant Kokiwar

Abstract


Background: Pleural effusion can be treated by antibiotics alone but thoracoscopy assisted debridement has proved superior to antibiotics alone. There is need to study this aspect in more details related to the superiority of the treatment. The objective was to study efficacy of early thoracoscopic debridement for syn-pneumonic pleural effusions in pediatric age group.

Methods: A hospital based follow up study was carried out among 40 children of 1-7years of age. They were divided into two groups. One group with 15 children received only antibiotics while the other group with 25 children received thoracoscopic debridement. The results were compared in terms of hospital stay and clinical outcome.

Results: It was found that the hospital stay was significantly shorter in children who received thoracoscopic debridement compared to antibiotic group. The chest X-ray was normal in all cases who received thoracoscopic debridement compared to antibiotic group. Decortications were required in five children in antibiotic group compared to none who received thoracoscopic debridement. There was no morbidity and mortality in the children received thoracoscopic debridement. Clinical and symptomatic relief was much better in children received thoracoscopic debridement compared to antibiotic group where there was persistence of the symptoms.

Conclusions: Thoracoscopy done in 3days of syn-pneumonic effusions give better out come in terms of hospital stay, morbidity, radiological resolution, compared to thoracocentesis done cases.


Keywords


Debridement, Efficacy, Pleural effusions

Full Text:

PDF

References


Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatric Infectious Dis J. 2003;22(6):499-503.

Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infectious Dis. 2002;34(4):434-40.

Byington CL, Korgenski K, Daly J, Ampofo K, Pavia A, Mason EO. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatric Infectious Dis J. 2006;25(3):250-4.

Le Saux N, Robinson JL. Pneumonia in healthy Canadian children and youth: Practice points for management. Paediatrics Child Health. 2011;16(7):417-20.

Grewal H, Jackson RJ, Wagner CW, Smith SD. Early video-assisted thoracic surgery in the management of empyema. Pediatrics. 1999;103(5):e63-.

Koppurapu V, Meena N. A review of the management of complex para-pneumonic effusion in adults. J Thoracic Dis. 2017;9(7):2135.

Knudtson J, Grewal H. Pediatric empyema–an algorithm for early thoracoscopic intervention. JSLS. 2004;8(1):31.

Oak SN, Parelkar SV, Satishkumar KV, Pathak R, Ramesh BH, Sudhir S, et al. Review of video-assisted thoracoscopy in children. J Minimal Access Surg. 2009;5(3):57.

Pappalardo E, Laungani A, Demarche M, Erpicum P. Early thoracoscopy for the management of empyema in children. Acta Chirurgica Belgica. 2009;109(5):602-5.

Kang DW, Campos JR, Andrade Filho LD, Engel FC, Xavier AM, Macedo M, et al. Thoracoscopy in the treatment of pleural empyema in pediatric patients. J Brasileiro Pneumol. 2008;34(4):205-11.

Alexiou C, Goyal A, Firmin RK, Hickey MS. Is open thoracotomy still a good treatment option for the management of empyema in children?. Ann Thoracic Surg. 2003;76(6):1854-8.

Liu HP, Hsieh MJ, Lu HI, Liu YH, Wu YC, Lin PJ. Thoracoscopic-assisted management of postpneumonic empyema in children refractory to medical response. Surg Endoscopy. 2002;16(11):1612-4.