Abstract
Empyema thoracis continues to remain a serious complication of Pneumonia in children. A number ofstudies are available on demographics, etiology and treatment of empyema but no useful information isavailable on hemodynamic changes occurring in response to acute empyema. Therefore we aimed to evaluatethe serial haemodynamic changes in children with acute empyema and their correlation with severity andout come of the disease.Serial haemodynamic changes were studied prospectively in 25 children with acute empyema before andafter the placement of chest tube and subsequently on day 1, 2, 3 and 10 of hospitalization. Twenty-five ageand sex matched children served as their controls.Their age ranged from 8 months to 12 years (mean 4.2 years). Severity of empyema was graded as mild,moderate and severe in 11, 6 and 8 children respectively. Staphylococcus aureus was the commonestorganism isolated in 11 children. At admission all the children were febrile (mean temp 39.4C) hadtachycardia (mean HR136/mt) and tachypnea (mean RR 62/mt).While CVP was high (10.2? 4cm H2O), thesystolic (102 ? 4mmHg) and mean arterial pressure(77? 3mmHg) was at lower side as compared to theircontrols.The mean changes observed after the chest tube placement were HR- 6/mt; RR - 4.44/ mt; SBP+5mmHg; DBP +2.04mmHg; MAP +3mmHg and CVP-3.1cm H2o (p <.001). Children with severe diseasehad significantly higher CVP (15 ? 3.3cmH2o), low SBP (99 ? 3mmHg) and low serum Sodium (128? 5mEq/L) and Osmolality (278 ? 9 mOsm/L) compared to those with mild or moderate disease. (p<.05 foreach factor).Seven children had features suggestive of syndrome of inappropriate ADH secretion. All thischildren belonged to severe category.It was concluded that hemodynamic compromise is a common occurrence in children with empyema. HighCVP, low SBP, low serum Na+ and Osmolality correlate best with the severity of the disease.Key Words: Empyema, Hemodynamics, Children.
Highlights
In children, empyema thoracis accounts for 8.6% of hospital admissions for lower respiratory infections and about 2% of total hospital admissions in developing countries.[1,2,3] In an epidemiological investigation, Byrington et al indicated much higher rate of empyema (30%) as post pneumonia complications.[4]
The diagnosis of empyema was confirmed by aspiration of pus from pleural cavity and all the children were managed in ICU according to the standard protocol comprising of antibiotics, closed tube drainage, I/V fluids and O2 if required, subsequent changes in antibiotics were made according to culture sensitivity/ clinical response
The main hemodynamic abnormalities observed in Children with acute empyema were low systolic BP, raised Central Venous Pressure (CVP), hypoxia and evidence of dilutional hyponatremia beside tachycardia and tachypnea
Summary
Empyema thoracis accounts for 8.6% of hospital admissions for lower respiratory infections and about 2% of total hospital admissions in developing countries.[1,2,3] In an epidemiological investigation, Byrington et al indicated much higher rate of empyema (30%) as post pneumonia complications.[4]. The death rate of empyema varies from 1.3%36% in hospitalized children.[3,5] Mostly, deaths are reported within 48-72 hours of hospitalization and have been attributed to the unrelieved tension inside the thoracic cavity.[2,6] In a recent study all the deaths of childhood empyema (6.3%) were attributed to heart failure with congestive heart failure reported as a most frequent complication in empyema (33.3%).[7]
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
