Management of empyema in children

doi:10.1016/0002-9610(89)90207-9

The American Journal of Surgery

Volume 158, Issue 6, December 1989, Pages 618-621

https://doi.org/10.1016/0002-9610(89)90207-9 Get rights and content

Abstract

The antibiotic era has changed the incidence, causal factors, and gravity of empyema. Between 1977 and 1988, 27 children with empyema were surgically managed. Ten cases occurred after an operation (8 esophageal and 2 abdominal). There were 15 girls and 12 boys. The age range was newborn to 12 years. Symptoms included fever, cough, tube drainage postoperatively, anorexia, weight loss, chest pain, tachypnea, and lymphadenitis. Multiple aerobic and anaerobic organisms were cultured. Treatment included thoracentesis and antibiotics, tube thoracostomy, tube thoracostomy and bronchoscopy, decortication, or decortication with lobectomy. The total hospital stay averaged 28.3 days, and after decortication, 11.6 days. Empyemas in children frequently have multiple organisms and should be treated with broad-spectrum antibiotics while awaiting culture results. Thoracentesis and tube thoracostomy are often ineffective in curing the disease. Decortication can abbreviate hospital stay if performed promptly for persistent pleural sepsis.

References (19)

P Mayo et al.
Acute empyema in children treated by open thoracotomy and decortication
Ann Thorac Surg
(1982)
JN Middelkamp et al.
The changing pattern of empyema thoracis in pediatrics
J Thorac Cardiovasc Surg
(1964)
AM Kosloske et al.
Early decortication for anaerobic empyema in children
J Pediatr Surg
(1980)
A Muskett et al.
Management of refractory empyema with early decortication
Am J Surg
(1988)
JH Lemmer et al.
Modern management of adult thoracic empyema
J Thorac Cardiovasc Surg
(1985)
RP Foglia et al.
Current indications for decortication in the treatment of empyema in children
J Pediatr Surg
(1987)
JG Raffensperger et al.
Mini-thoracotomy and chest tube insertion for children with empyema
J Thorac Cardiovasc Surg
(1982)
GE Lindskog
The changing picture of pleural empyema
Arch Surg
(1956)
MM Ravitch et al.
The changing picture of pneumonia and empyema in infants and children
JAMA
(1961)

There are more references available in the full text version of this article.

Cited by (25)

PLEURAL EFFUSIONS AND EMPYEMA
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition
Cefuroxime vs a dicloxacillin/chloramphenicol combination for the treatment of parapneumonic pleural effusion and empyema in children
2002, Pulmonary Pharmacology and Therapeutics
The aim of this study was to evaluate the efficacy of cefuroxime, compared with the combination of dicloxacillin/chloramphenicol, for the treatment of children with parapneumonic pleural effusion or empyema. Forty patients, aged 3 months to 5 years, with pleural effusion or empyema were randomized to receive cefuroxime (100 mg/kg/day) IV (n=20) or chloramphenicol (100 mg/kg/day) plus dicloxacillin (200 mg/kg/day) IV (n=20). Both groups were similar in age, days of illness, clinical and radiological findings, and etiology. Most patients (70%) had an empyema at presentation. There was no difference in clinical outcomes, including days to defervescence, duration of respiratory distress, duration of chest tube drainage, and days to discharge from hospital. The complication rates were similar in both groups. Pleural thickening occurred in four patients, bronchopleural fistula in two, and loculated empyema in one patient of each treatment group. Adverse effects attributed to cefuroxime were mild and infrequent. These results suggest that cefuroxime is an effective and well-tolerated alternative for the treatment of children with pleural effusion and empyema.
Empyema: Development of a critical pathway
2002, Seminars in Pediatric Surgery
Over the past 20 years at the authors' institution, the management of empyema has evolved. The authors recently have developed a critical pathway in an effort to facilitate diagnosis, guide therapy, and reduce cost. Currently, the average length of stay using this pathway is 4 to 5 days with decreased cost compared to the historic length of stay and a national children's hospital database. The authors review steps to develop a critical pathway as well as discuss their pathway for empyema management.
Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema: A case series
2000, Chest
Citation Excerpt :
Of these, 11 patients required the placement of a second chest tube, 8 subsequently needed open decortication, and 3 underwent lobectomy for pulmonary abscess.1 Two studies have demonstrated a good outcome after surgical drainage.2,10 Many authors, therefore, advocate early thoracotomy and decortication in children and adults who have not responded to standard therapy.11–14
Previous articles have promoted the early use of thoracotomy and decortication for refractory empyema. This study examines thoracoscopy and decortication at the time of initial chest tube placement in pediatric patients with parapneumonic empyema.
We reviewed the medical records of 16 consecutive patients who were children with parapneumonic empyema.
Thirteen children (group 1) underwent thoracoscopic decortication and tube thoracostomy as their initial operative procedures; 3 children (group 2) had tube thoracostomy alone. In both groups, chest tubes were removed prior to their discharge to home. The mean (± SD) operative time for thoracoscopy was 81 ± 19 min with no complications. On average, chest tubes were removed by postoperative day 4. The mean time to discharge was 8.3 days. Two children eventually required lobectomy. The mean operative time for chest tube placement alone was 21 ± 3 min. Children required chest tube drainage for an average of 12.3 days. The mean time to discharge was 16.6 days. Two patients required a total of five additional operative procedures, including two additional chest tube placements, two open decortications, and one lobectomy.
Thoracoscopic decortication is effective in the early treatment of pediatric parapneumonic empyema. It facilitates visualization, evacuation, and mechanical decortication of the pleural space with no additional morbidity and may lead to reduced time for chest tube drainage, shorter hospitalization, and more rapid clinical recovery.
50 years of thoracic and cardiac surgery at the Southwestern Surgical Congress: From tuberculosis to the artificial heart
1998, American Journal of Surgery
Common pleural effusions in children
1998, Clinics in Chest Medicine

View all citing articles on Scopus

^☆: Presented at the 41st Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 23–26, 1989.

¹: From the Departments of Surgery and Pediatrics, University of Arkansas for Medical Sciences and the Arkansas Children's Hospital, Little Rock, Arkansas.

View full text

Scientific paperManagement of empyema in children☆

Abstract

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Pediatr Surg

Am J Surg

J Thorac Cardiovasc Surg

J Pediatr Surg

J Thorac Cardiovasc Surg

The changing picture of pleural empyema

Arch Surg

The changing picture of pneumonia and empyema in infants and children

JAMA

Scientific paper
Management of empyema in children☆