Abstract
BackgroundChest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.ObjectiveTo evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital.Materials and methodsThis was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre.ResultsThree hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery.ConclusionOur technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.
Highlights
Parapneumonic effusion and empyema are well-recognised complications of pneumonia in children, resulting in significant morbidity and hospital admission
Through paediatric respiratory and radiology databases, all children admitted with pneumonia and parapneumonic effusion/empyema requiring drain insertion between January 1, 2001, and December 31, 2016
Over the 16-year period, 303 drains were inserted into 285 children (112 female; median age: 5.2 years, age range: 0.5– 15.9 years) for complicated parapneumonic effusion or empyema
Summary
Parapneumonic effusion and empyema are well-recognised complications of pneumonia in children, resulting in significant morbidity and hospital admission. The incidence in the developing world appears to be increasing, outcomes following treatment are excellent, long-term complications are rare and mortality rates almost negligible [1, 2]. Antibiotics alone may suffice in some patients, those with large or more complicated effusions and those not responding to medical management frequently require drainage. The optimal treatment is contentious, but there is agreement that either chest tube drainage with intrapleural fibrinolytics or videoassisted thoracoscopic surgery are the treatments of choice [3]. Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. The additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
