Parapneumonic Effusion In Children Research Articles

Efficacy of dexamethasone as adjunctive therapy in the treatment of parapneumonic pleural effusion in children

Background Parapneumonic effusion (PPE) occurs as a complication in around 13% of instances of community-acquired pneumonia. Aim To assess the effect of dexamethasone as an adjunctive therapy in the treatment of PPEs in children. Patients and methods This is a double-blinded, parallel-group, placebo-controlled, randomized clinical trial carried out on 60 children aged from 1 to 13 years with pneumonia complicated by PPEs. Patients were randomly divided into two equal groups (with the usual treatment in the form of double antibiotics given to all) and either intravenous dexamethasone at a dose of 0.25 mg/kg every 12 h for 3 days (group A) or intravenous saline every 12 h for 3 days as placebo (group B). Results Duration of hospitalization, chest tube insertion, and number of patients referred to the pediatric intensive care unit were significantly lower in group A than in group B (P=0.007, P<0.001 and P=0.025, respectively). Normal PPE was significantly higher in group A than in group B (P=0.025) after 2 weeks, and small PPEs were significantly higher in group A than group B (P=0.008) on the 7th day. Fluid thickness by chest ultrasound on the 7th day was significantly lower in group A than in group B (P=0.016). Conclusion Dexamethasone was an effective adjunctive therapy for PPEs in children.

Treatment of Parapneumonic Effusion in Children.

To the Editors: We read the article by Lohuis et al1 regarding conservative treatment of parapneumonic effusion in children. In their article, the authors stated that the greater amount of children with parapneumonic effusion (PPE) could be treated conservatively with antibiotics only, especially in the absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions. In a cohort of 136 patients, 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. They found patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58% vs. 3%, difference 55%; 95% confidence interval: 32%–77%). In the study patients treated conservatively, median duration of hospitalization was 5 days (Interquartile range: 4–112) compared with 19 days (Interquartile range: 15–24) in the drainage group (P < 0.001), without significant difference in readmission rate (11% vs. 4%). Children with pneumonia can admit initially with an effusion that is in any one of the stages of evolution. The stage of evolution of the parapneumonic process and what therapy has already been provided is the key point for treatment. As in the study of Lohuis et al1 not all the patients were evaluated with ultrasonography, it is not possible to state how benign or complicated were PPE in the initial phase, since the cohort is not large enough to generalize to whole population and it is not easy to say PPE could be treated conservatively with antibiotics only, this statement might change due to geographic location, immunization schedules or surveillance data. For patients with parapneumonic effusions, clinicians can use ultrasound to quantify and characterize pleural fluid to determine whether diagnostic or therapeutic drainage is indicated, as well as to guide whether intrapleural fibrinolytics or surgical treatment is needed.2 In our center, 48 patients between 1 and 17 years of age from January 2011 to December 2016 were diagnosed with PPE, tube thoracostomy was performed in 43 of 48 (89.6%). Patients treated with fibrinolytic therapy was 22 (45.8%) and the mean dose was 5.18 ± 2.59 (1–9) in total. Fibrinolytic therapy was significantly higher in PE stage (II) than the other stages (P = 0.001). Intensive care need was 20.8% (n = 10), while total hospital stay was 23.58 ± 8.69 (3–47) days. Thoracotomy/decortication or Video assisted thoracoscopic surgery were required in 5 (10.4%) patients. There was no significant relationship between the operation and fibrinolytic treatment status of patients. The complication rate was 41.6% in total.3 Similarly, Lohuis et al1 also discussed that thoracic ultrasound could play a more important role in the decision making for the favorable treatment option with either conservative management or pleural drainage. Their study suggests that a Computed tomography scan does not play a major role in the diagnosis and treatment of PPE in children. These studies highlighting therapy of parapneumonic effusion in children are very helpful to guide clinicians and more randomized controlled trails are warranted.

Parapneumonic effusion in children: Rapid pathogen detection in pleural fluid using multiplex bacterial PCR.

Parapneumonic effusion in children: Rapid pathogen detection in pleural fluid using multiplex bacterial PCR.

The thoracoscopic approach in the management of parapneumonic pleural effusion in children

Background: Parapneumonic pleural effusion is a relatively common entity and continues to be a major cause of morbidity in children. However, managing this disease is still a matter of controversy between surgical and non-surgical options. With the advancement of mini-invasive surgery, video-assisted thoracoscopic surgery (VATS) has become a mainstay in the treatment of parapneumonic effusion in children. This study aimed to evaluate the clinical characteristics and pathological features of parapneumonic pleural effusion in children and to explore the feasibility and safety of the thoracoscopic approach in the pediatric population. Methods: The clinical data of all patients who underwent VATS for parapneumonic effusion between 2007 and 2021 were analyzed retrospectively. Factors that were documented included demographic criteria, clinical manifestations, preoperative examinations, therapeutic procedures, intraoperative findings, postoperative complications, and outcomes. Results: Totally, 35 patients with a mean age of 5.14 ± 3.9 years were operated on thoracoscopically. The mean duration of evolution before VATS was 9 days ± 4. All children were hospitalized in a Pediatric Continuing Care Unit. Antibiotic therapy was administrated in combination in all cases. Corticosteroid therapy was used in 2 patients. Thoracentesis was performed in 6 patients. Thoracostomy tube drainage was placed before surgery in 11 patients. The average duration of drainage before VATS was 6 days ± 4. VATS decortication and/or debridement was indicated as second-line in 23 patients. The average duration of the surgery was 51 minutes (20 min - 115 min). There is no conversion to open surgery and no intraoperative procedure-dependent complication. 4 children have early complications after the VATS and one patient had a late postoperative complication. There were no deaths during the hospital stay or follow-up. Conclusion: In skilled hands, VATS is safe, feasible, and effective in the management of parapneumonic pleural effusion in children with excellent outcomes.

Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series.

In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE. A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1-18 years treated for PPE between January 2010 and June 2020. One hundred thirty-six patients were included (mean age 8.3 years, SD 4.8). 117 patients (86%) were treated conservatively and 19 (14%) underwent pleural drainage. Patients undergoing pleural drainage had mediastinal shift more frequently compared with conservatively treated patients (58 vs. 3%, difference 55%; 95% CI: 32%-77%). The same accounted for pleural septations/pockets (58 vs. 11%, difference 47%; 95% CI: 24%-70%), pleural thickening (47 vs. 4%, difference 43%; 95% CI: 20%-66%) and effusion size (median 5.9 vs. 2.7 cm; P = 0.032). Conservative management was successful in 27% of patients (4 of 15) with mediastinal shift, 54% of patients (13 of 24) with septations/pockets, 36% of patients (5 of 14) with pleural thickening, and 9% of patients (3 of 32) with effusions >3 cm, all radiological signs generally warranting pleural drainage. In patients treated conservatively, median duration of hospitalization was 5 days (IQR 4-112) compared with 19 days (IQR 15-24) in the drainage group ( P < 0.001), without significant difference in readmission rate (11 vs. 4%, difference 6%; 95% CI: -8%-21%). This study suggests that the greater amount of children with PPE could be treated conservatively with antibiotics only, especially in absence of mediastinal shift, pleural septations/pockets, pleural thickening or extensive effusions.

Comparison of Clinical Efficacy between Alteplase 0.1 mg/kg and 4 mg for Complicated Parapneumonic Effusion in Children

Background: Intrapleural alteplase for the treatment of complicated parapneumonic effusion has been shown to reduce the surgical rate, duration of hospitalization, and time to defervescence, and improve pleural fluid drainage. However, there are various regimens of alteplase administration. Objective: To compare the efficacy and safety between intrapleural alteplase 0.1 mg/kg and 4 mg in the management of complicated parapneumonic effusion. Materials and Methods: An observational historical cohort study was conducted in patients aged between three months and 15 years diagnosed with complicated parapneumonic effusion or empyema thoracis. The patients were divided into two groups. The first group was patients enrolled between January 2012 and December 2019 and receiving alteplase 4 mg/dose. The second group was patients were enrolled between April 2020 and March 2021 and receiving alteplase 0.1 mg/kg/dose with a maximum of 4 mg. Intrapleural alteplase was given once a day for three consecutive days. Baseline characteristic, clinical outcome, adverse effect, and treatment costs were recorded. The data were statistically analyzed. Results: Thirty patients were enrolled with 20 in the 4 mg group and 10 in the 0.1 mg/kg group. There were no significant differences between the two groups with regards to treatment success rate, time to defervescence, and total pleural fluid drainage. One patient in the 0.1 mg/kg group required surgical treatment. Patients in the 0.1 mg/kg group had significantly shorter duration of hospitalization at 10 versus 13 days (p=0.03) and lower costs of treatment compared with the 4 mg group at 15,388.50 versus 22,214.75 Baht (p=0.03). Intrapleural bleeding was found in one patient in the 4 mg/dose group. Conclusion: Intrapleural alteplase in the dose of 0.1 mg/kg and that of 4 mg have good clinical efficacy for treatment of complicated parapneumonic effusion. The 0.1 mg/kg group is safe and associated with lower cost of treatment, and shorter hospital stays. Keywords: Intrapleural alteplase; Tissue plasminogen activator; Complicated parapneumonic effusion

Empyema and Parapneumonic effusions in children admitted to a teaching hospital in Ghana. -A retrospective review

Background&#x0D; Parapneumonic effusions (PPE) and Empyema are serious complications of pneumonia in children that are associated with higher morbidity and prolonged hospital stay. The introduction of the pneumococcal conjugate vaccines (PCV 13) have led to a reported decline in the episodes of complicated pneumonia in children. The organisms commonly associated with PPE and Empyema are Streptococcus pneumoniae and Staphylococcus aureus though Mycobacterium tuberculosis has also been reported. There is paucity of data on children with PPE and Empyema in Ghana. We aimed to describe the profile, mode of presentation and outcomes in children admitted with PPE and Empyema to the Komfo Anokye Teaching Hospital.&#x0D; Methods&#x0D; A retrospective review of medical records (folders) and electronic data on children with PPE and Empyema admitted to the pulmonology unit from January 2018 to December 2020 were retrieved. Demographic records, immunization status, clinical presentation, length of hospital stay and outcome of admission were extracted using a Microsoft Excel. Data was then analysed with STATA version 16.&#x0D; Results&#x0D; Records were available for 51 children; the median age was 42 months IQR (22.5-96) and 68.6% (n=35) were males. In all 84.2% (n=38), had received all immunisations up to date for age. At presentation, 9.5% (n=4/42) had oxygen saturation &lt;90%, whilst 43.9% (n=18/41) had axillary temperature &gt; 38oC. The median respiratory rate was 47.5 IQR (32.8-57). The Median white cell count was 15.84 X10 9/l IQR (11.9-24.73) and median hemoglobin was 9.6 g/dl IQR (8.6-11.7). Pleural aspirate culture isolated Staphylococcus aureus for 6 patients. The rest were either not available or had no bacterial growth. Amoxicillin clavulanic acid and ceftriaxone were the most commonly used antibiotics. The median length of hospital stay was 9 days IQR (7-12) while the median length of chest tube insertion was 7 days IQR (5.5-9). In all 7.8 (n-4/51) patients died.&#x0D; Conclusion&#x0D; Both young and older children are affected with PPE/empyema. There is a good uptake of vaccines among children admitted for PPE/empyema, Staphylococcus aureus is the most common bacterial isolated from pleural aspirate culture. Most children admitted with complicated PPE/Empyema survived.

Pleural Thickening after Pleural Effusion: How can we Follow-Up in Children?

No clear information exists about the factors affecting pleural thickening following parapneumonic effusion in children. We aimed to investigate factors that affect the resolving time of pleural thickening after parapneumonic effusion. Between the years of 2007-18, 91 patients, which were followed due to diagnosis of pleural thickening after parapneumonic effusion, were assessed. Ages, complaints, physical examination findings, laboratory results, chest x-ray and ultrasonography findings, treatments, duration of treatment and recovery time of the patients were examined terms in of pleural thickening resolving time. The mean age of patients was 7.5 ± 5.0 years. Pleural thickening resolving time was 151 ± 6.8 days. The resolving time for pleural thickening was delayed with older ages, longer duration of complaints, fever before hospital admission and treatment, lower oxygen saturation at the time of admission, crackles in the physical examination, higher white blood cell count and pleural fluid density (p = 0.018, p = 0.001, p = 0.021, p = 0.020, p = 0.024, p = 0.025, p = 0.021, p = 0.019). In addition, the amount of effusion measured by thorax ultrasonography, fibrinolytic usage, and complications had a role in the delayed resolving time (p = 0.034, p = 0.001, p = 0.034). Pleural thickening resolved in 80% of the patients. In this report, 80% of pleural thickening, following parapneumonic effusion resolved within 5 months. Patients who do not have a complication during follow-up are not required to monitor with frequent chest x-ray. Patients with a higher amount of pleural effusion, complications and need for fibrinolytic treatment should be followed more carefully.

Detection of Respiratory Pathogens in Parapneumonic Effusions by Hypothesis-free, Next-Generation Sequencing (NGS)

BackgroundSpecies-specific polymerase chain reaction (PCR) testing of pleural fluid (PF) from children with parapneumonic effusion (PPE) has increased pathogen identification in pediatric PPE. However, a pathogen is not detected in 25–35% of cases. Hypothesis-free, next-generation sequencing (NGS) provides a more comprehensive alternative and has led to pathogen detection in PCR-negative samples. However, the utility of NGS in the evaluation of PF from children with PPE is unknown.MethodsArchived PF (n = 20) from children younger than 18 years with PPE and hospitalized at Primary Children’s Hospital, Utah, in 2015 and previously tested by PCR were evaluated. Ten PCR-negative and 10 PCR-positive PF specimens were tested using RNA-seq at an average depth of 7.7×106 sequencing reads per sample. NGS data were analyzed with Taxonomer. We compared pathogens detected by blood and PF culture, PCR, and NGS.ResultsOverall, compared with blood/PF culture, PF PCR and PF NGS testing of PF increased bacterial identification from 15% to 50% (P < 0.05) and 65% (P = 0.003), respectively. Pathogen detection in PF by PCR and NGS were comparable (50 vs. 65%, p = NS) (Table). However, compared with PF PCR, NGS significantly increased detection of S. pyogenes (20% vs. 55%; P < 0.05), with 100% concordance when detected by PCR and culture. Detection of Fusobacterium spp. (10 vs. 10%) by PF NGS and PF PCR were comparable. In contrast, there was no detection of S. pneumoniae (15 vs. 0%) by PF NGS compared with PF PCR.ConclusionPF NGS testing significantly improves bacterial identification and comparable to PF PCR testing, which can help inform antimicrobial selection. However there were differences in detection of S. pneumoniae and S. pyogenes. Further studies of NGS testing of PF of children with PPE are needed to assess its potential in the evaluation of PPE in children.Positive by culturea and PCR (n = 10)Negative by culturea and PCR (n = 10)PathogenCultureaPF PCRPF NGSCultureaPF PCRPF NGS S. pneumoniae 030000 S. pyogenes 145006MRSA010000 Fusobacterium spp.222000Total3107006 aCulture includes both blood and PF.Disclosures A. J. Blaschke, BioFire Diagnostics LLC: Collaborator, Have intellectual property in BioFire Diagnostics through the University of Utah and Investigator, Licensing agreement or royalty and Research support; R. Schlaberg, IDbyDNA: Co-founder, Consultant and Shareholder, Stock

Pleural Effusions and Pneumothoraces.

1. Katherine Cashen, DO* 2. Tara L. Petersen, MD† 1. *Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI 2. †Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI * Abbreviations: BTS: : British Thoracic Society CHF: : congestive heart failure CT: : computed tomography VATS: : video-assisted thoracoscopic surgery 1. Clinicians should be aware of the causes and clinical presentation of pleural effusions and pneumothoraces. 2. Clinicians should understand the current role of diagnostic tests, imaging modalities, and timing of minimally invasive treatments. After completing this article, readers should be able to: 1. Describe the pathogenesis of pleural fluid accumulation. 2. Identify the most likely causes of pleural effusion and pneumothorax. 3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces. 4. Differentiate between transudative and exudative pleural effusions. 5. Understand the natural history of spontaneous pneumothorax. The pleural space is created by the parietal and visceral pleura that line the chest wall and the lung surface, respectively. Normally, only a small amount (0.3 mL/kg) of hypotonic fluid is present within the pleural space due to homeostatic balances in physiologic fluid production and absorption. Various infectious and noninfectious processes can lead to pathologic filling of the pleural space with fluid (effusion) or air (pneumothorax). Such pathologic changes create a true space that can interfere with normal lung mechanics and, in severe cases, cardiac function. Although much less common in pediatric than adult populations, pleural effusions and pneumothoraces in both groups can lead to substantial complications, resulting in significant morbidity and mortality if unrecognized or untreated. Overall, the cause of pleural effusions and pneumothoraces differs in children compared to adults. In adults, congestive heart failure (CHF) and malignancy account for a substantial number of pleural effusions, but these are uncommon causes in children. Infectious pleural effusions in the setting of pneumonia (parapneumonic effusions) remain the most common cause of effusions in both children and adults. Unlike the adult population, children experience spontaneous …

Parapnömonik Efüzyonlu Çocuklarda Plazma Antioksidatif/Oksidatif Seviyelerinin Tanı Değeri Nedir?

Parapnömonik Efüzyonlu Çocuklarda Plazma Antioksidatif/Oksidatif Seviyelerinin Tanı Değeri Nedir?

Pneumonia with empyema among children in the first five years of high coverage with 13-valent pneumococcal conjugate vaccine

Background: Parapneumonic effusions in children are usually associated with pneumococcal infections. In Greece, the 7-valent pneumococcal conjugate vaccine was replaced by higher-valent pneumococcal conjugate vaccines (PCVs); 10-valent was introduced in May 2009 and 13-valent (PCV13) in June 2010. Since July 2010, PCV13 has been the most commonly used PCV. In a study conducted at the University General Hospital of Larissa, Central Greece, from January 2012 to January 2016, 85.7% of children born after the implementation of PCV13 and aged 24–59 months had received the complete series (3 + 1 immunization schedule) of PCV13.Methods: We studied all paediatric community-acquired pneumonia cases with empyema hospitalized at the University General Hospital of Larissa from January 2008 to January 2016.Results: There were 30 cases of parapneumonic empyema. Among 27 empyema cases of known aetiology, 19 (70.4%) were due to Streptococcus pneumoniae (identifiable serotypes 3, 19A, 7F, and 9N/L). After September 2011, no more cases caused by serotypes 7F and 19A were observed, whereas serotype 3 emerged as the predominant pathogen of pneumococcal empyema (9 of 11 cases). Serotype 3 continued to cause empyema despite vaccination with PCV13 either fully with a 3 + 1 schedule (n = 3) or with one booster dose at the age of 21 months (n = 1).Conclusion: In Central Greece during the first five years of high coverage with PCV13, serotype 3 was the only PCV13 serotype that clearly persisted in children with empyema.

Evaluation of complicated and uncomplicated parapneumonic effusion in children.

Parapneumonic effusion (PPE) and empyema are most often seen as a complication of bacterial pneumonia and occasionally associated with atypical bacteria or viruses. The aims of this study were to describe and compare demographic characteristics, clinical, laboratory, microbiological findings and treatment modalities of patients with PPE and empyema. We retrospectively reviewed 116 pediatric patients with PPE and empyema. Seventy (60.3%) had pleural empyema and 46 patients (39.6%) had PPE. The median age of patients with empyema [72.0 months (IQR 68.0 months)] was lower than the patients with PPE [92.5 (IQR 80.0 months)] (p=0.003). Children in the empyema group had significantly more dyspnea symptoms than the children with PPE (p=0.022). Mean fever duration before hospitalization was similar in both groups. Streptococcus pneumoniae and group A streptococcus were the most common causes of empyema. All of the patients were treated with intravenous antibiotics. In addition to medical treatment, tube thoracostomy was performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%) of them required intrapleural fibrinolysis also. In the presence of antibiotic treatment failure or in cases with moderate or large pleural effusion with loculations and clinical deterioration; it is necessary to perform drainage of the purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics or to perform video-assisted thoracoscopic surgery (VATS), in order to enhance prompt recovery.

Lack of concordance in parapneumonic effusion management in children in central Europe.

Treatment of parapneumonic effusion in children remains controversial in the literature and in clinical practice. The aim of this study was to determine whether mutual consensus exists in the diagnosis and treatment of parapneumonic effusion in Central European countries. A questionnaire was sent to all directors of pediatric respiratory units in four adjacent Central European countries (Austria, France, Germany, Switzerland). The response rate was 61.8%. Responses reflected acceptable agreement regarding initial diagnostic procedures, as most centers performed chest X-ray and biological exams, followed by ultrasound, thoracocentesis, or computed tomography. However, antibiotic regimens were very heterogeneous, and the survey revealed complete lack of agreement on the indications and effusion volume threshold for invasive procedures, such as fibrinolytic instillation and thoracoscopy. In conclusion, apart from initial diagnostic procedures, this study showed a lack of mutual consensus among the four countries regarding the management of pediatric parapneumonic effusion. Multicenter prospective trials are clearly needed to acquire more evidence on the management of childhood parapneumonic effusion, enabling the development of evidence-based algorithms that could help to avoid unnecessary examinations with potential long-term side effects, such as radiation exposure at a young age.

Direct Streptococcus pneumoniae real-time PCR serotyping from pediatric parapneumonic effusions.

BackgroundTo determine the serotypes of Streptococcus pneumoniae responsible for pneumonia complicated by parapneumonic effusion in children, we performed real-time PCR based pneumococcal “serotyping” directly on parapneumonic fluid samples.MethodsSpecimens were collected at two children’s hospitals in Ontario, Canada from 2009 to 2011. Samples in which S. pneumoniae was detected by PCR were tested with serotype-specific 5′exonuclease PCR assays for the 13 serotypes contained in the 13-serotype pneumococcal vaccine.ResultsThirty-five S. pneumoniae PCR-positive pleural samples were studied. Pneumococcal serotyping PCR assays were positive for 34 of 35 (97%). Serotype 3 was detected most frequently, in 19/35 (54%), followed by serotype 19A in 9/35 (26%), serotype 7 F/A in 4/35 (11%), serotype 1 in 1/35 (3%), and serotype 6A also in 1/35 (3%).ConclusionsPCR testing demonstrated that the vast majority (97%) of S. pneumoniae parapneumonic effusions were caused by serotypes present in the 13-serotype vaccine that were not present in the original 7 serotype vaccine. This suggests that use of the 13-serotype vaccine could potentially prevent many S. pneumoniae pneumonias complicated by parapneumonic effusion in our region, provided serotype replacement does not occur.

Survey of hospital procedures for parapneumonic effusion in children highlights need for standardised management.

This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course. Answers from paediatricians working in emergency departments, intensive care units and conventional paediatric units were compared. Of the 100 paediatricians contacted, 95 responded. Of these, 98% would order an initial blood test, 70% would order diagnostic thoracentesis, and all would start immediate antibiotic therapy: 31% with a single drug, 67% with two drugs and 2% with three drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (34%) or vancomycin (24%). Adaptation varied according to drug used, dose and duration, especially when the microorganism was not Streptococcus pneumoniae. Practices did not differ significantly among the different groups of paediatricians. Standardised management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.

Long-term outcome of parapneumonic effusions in children: Lung function and exercise tolerance.

a: To evaluate the long-term outcome of parapneumonic effusions (PPE) in children regarding lung function and exercise tolerance, (b) to investigate the role of bronchial asthma in the outcome of PPE. The design of the study included 51 children with PPE, at least 2 years after the initial infection. They were divided in two groups. Group A (38 children) consisted of children with PPE but without asthma prior initial infection. Group B (13 children) included children with PPE and asthma prior infection. Thirty-six children were taken as healthy controls (group C). All children performed spirometry and a maximal incremental cardiopulmonary exercise test on cycle ergometer. Children of both groups (A and B) showed statistically significant lower values in FVC%, FEV1%, and FEV1 /FVC compared to controls (group C). Children of group B had also significant lower FEF(25-75%) values compared to controls. Children of group B had significant lower FEV1 /FVC values compared to group A. All children of the three groups showed no differences in maximal exercise capacity (VO2max). Children of group A had higher respiratory equivalent to oxygen (VE/VO2) during exercise compared to healthy subjects. There are small effects on lung function and exercise capacity in the long-term, among children with PPE, but of no clinical importance. Pre-existing bronchial asthma doesn't influence the outcome significantly.

The Role of Thoracoscopic Decortication in the Treatment of Childhood Empyema

Pneumonia associated with parapneumonic effusion in children continues to be a common and, at times, a difficult problem to manage. While the majority of children can be treated with antibiotic therapy alone, once the effusion reaches the fibropurulent stage or later, the organizing stage treatment can become more complicated. In the past, once the empyema, these later stages, it was treated with antibiotics, prolonged chest tube drainage, and, if these failed, open thoracotomy for debridement. This was associated with long hospitalization and significant morbidity due to the delayed referral to a surgeon and to the surgical procedure itself. With the expanded use of endoscopic techniques, thoracoscopy has been increasingly used in the treatment of empyema and much earlier in the course of disease. The procedure can be performed quickly and efficiently through 2–5-mm incisions with minimal morbidity. Studies have shown that early thoracoscopic intervention can result in quicker recovery, a decreased length of hospital stay, and earlier return to normal activity, with minimal, if any, increased cost. These facts make this procedure ideal for the treatment of empyema in children.

Comparison of Pigtail Catheter With Chest Tube for Drainage of Parapneumonic Effusion in Children

The use of thoracostomy tube for drainage of parapneumonic effusion is an important therapeutic measure. In this study, we compared the effectiveness and complications between chest tube and pigtail catheter thoracostomy for drainage of parapneumonic pleural effusion in children. We retrospectively reviewed the medical records of children with parapneumonic effusion during the period of July 2001 through December 2003. Patients who received thoracostomy with either chest tube or pigtail catheter were enrolled into this study. Medical records, such as age, sex, clinical presentation, subsequent therapies, hospital stay, laboratory data, and complications, were collected and compared between these two methods of intervention. A total of 32 patients (17 boys and 15 girls; age range, 2-17 years; mean age, 14 years) were enrolled into the study. Twenty patients were treated with traditional chest tubes, whereas 12 patients were treated with pigtail catheters. In the chest tube group, drainage failure occurred in one patient and pneumothorax occurred in two patients. In the pigtail catheter group, drainage failure occurred in two patients, but no case was complicated with pneumothorax. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group (6.0 ± 2.6 vs. 5.9 ± 3.8, p=0.66; 12.5 ± 5.6 vs. 17.3 ± 8.5, p=0.13). The effectiveness and complications of the pigtail catheter were comparable to those of the chest tubes.

Increased Incidence and Morbidity of Parapneumonic Effusions in Children During the 2009 H1N1 Pandemic

Increased Incidence and Morbidity of Parapneumonic Effusions in Children During the 2009 H1N1 Pandemic