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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> Os derrames pleurais podem complicar as pneumonias na popula&#231;&#227;o pedi&#225;trica&#46; Assumem especial import&#226;ncia pelas implica&#231;&#245;es na dura&#231;&#227;o do internamento&#44; geralmente prolongado&#44; e pela morbilidade associada&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivos&#58;</span> Caracterizar uma popula&#231;&#227;o de doentes com pneumonia complicada de derrame&#59; determinar os poss&#237;veis factores de progn&#243;stico a partir de dados cl&#237;nicos&#44; radiol&#243;gicos e anal&#237;ticos na admiss&#227;o&#59; e avaliar a influ&#234;ncia das interven&#231;&#245;es terap&#234;uticas na evolu&#231;&#227;o da doen&#231;a&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">M&#233;todos&#58;</span> Revis&#227;o casu&#237;stica dos doentes com idade inferior a 18 anos e derrame pleural parapneu m&#243;nico&#44; internados de Julho de 1997 a Junho de 2004 &#40;7 anos&#41;&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados&#58;</span> Foram estudados 118 casos&#44; 60&#37; do sexo masculino&#44; com idade m&#233;dia 7 anos&#46; A incid&#234;ncia de derrame pleural aumentou ao longo do per&#237;odo do estudo&#46; Verificou-se maior incid&#234;ncia de casos no Outono e no Inverno&#46; Na admiss&#227;o&#44; 60&#37; dos doentes apresentavam sinais de dificuldade respirat&#243;ria e 39&#37; dor tor&#225;cica&#46; Em 40&#37; dos doentes foram detectados septos pleurais na admiss&#227;o&#44; o que se associou a maior dura&#231;&#227;o de internamento e de antibioticoterapia e mais frequente necessidade de cirurgia&#46; Em 72&#37; dos doentes foi efectuada toracocentese &#40;pH m&#233;dio&#58; 7&#44;24&#41;&#46; Em 17&#37; foi poss&#237;vel isolar o agente&#58; <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> &#40;cinco&#41;&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;quatro&#41; e <span class="elsevierStyleItalic">Streptococcus pyogenes</span> &#40;quatro&#41;&#46; Foram submetidos a drenagem pleural 52&#37; e necessitaram de cirurgia 18&#37;&#46; A mediana da dura&#231;&#227;o de internamento foi de 15 dias e a m&#233;dia de 16&#44;4 dias &#40;2 a 51&#41;&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Discuss&#227;o</span>&#58; Associam-se a pior progn&#243;stico a presen&#231;a de&#58; sinais de dificuldade respirat&#243;ria&#59; septos&#59; empiema&#59; baixo valor no l&#237;quido pleural de pH&#44; glicose ou prote&#237;nas&#59; desidrogenase l&#225;ctica elevada no l&#237;quido pleural e prote&#237;na C-reactiva sangu&#237;nea aumentada&#46; A drenagem pleural e&#47;ou cirurgia mais precoces provavelmente diminuem o tempo de doen&#231;a e de internamento&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclus&#227;o</span>&#58; Os derrames parapneum&#243;nicos complicados s&#227;o tratados com &#234;xito em centros de refer&#234;ncia com experi&#234;ncia nos diferentes tipos de interven&#231;&#227;o que poder&#227;o ser necess&#225;rios&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009&#59; XV &#40;2&#41;&#58; 241-259</span></p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction&#58;</span> Pleural effusions can complicate pneumonias in children and adolescents and are usually associated with a long hospital stay and increased morbidity&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aims&#58;</span> To characterise a population of patients with parapneumonic pleural effusion and to establish possible prognostic factors on admission based on clinical&#44; imaging and analytical data&#46; To correlate treatment options with the outcome&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methods&#58;</span> Case review of patients under 18 years old with parapneumonic pleural effusion&#44; admitted between July 1997 &#8211; June 2004 &#40;7<span class="elsevierStyleHsp" style=""></span>years&#41;&#46;</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> 118 patients were included&#44; 60&#37; male&#44; with mean age 7 years&#46; The incidence of pleural effusion increased throughout the period of the study&#46; The admissions occurred predominantly in autumn and winter&#46; On admission 60&#37; of patients had respiratory distress and 39&#37; chest pain&#46; In 40&#37; loculations were found on admission and were associated with longer hospital stay&#44; longer course of antibiotic therapy and more frequent need for surgery&#46; Thoracentesis was performed in 72&#37; of patients &#40;mean pH pleural fluid 7&#46;24&#41;&#46; The aetiologic agent was identified in 17&#37; of cases&#58; <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> &#40;five&#41;&#44; <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;four&#41; and <span class="elsevierStyleItalic">Streptococcus pyogenes</span> &#40;four&#41;&#46; In our study&#44; 52&#37; of patients underwent pleural drainage and 18&#37; surgery&#46; Median length of hospital stay was 15 days with mean 16&#46;4<span class="elsevierStyleHsp" style=""></span>days &#40;2 &#8211; 51&#41;&#46;</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Discussion&#58;</span> Factors associated with worse prognosis were respiratory distress&#44; loculations&#44; empyema&#44; low pH in pleural fluid&#44; glucose or proteins in pleural fluid&#44; high lactic dehydrogenase level in pleural fluid and high serum C-reactive protein&#46; Pleural drainage and&#47;or surgery can shorten hospital stay and improve outcome&#46;</p><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusion&#58;</span> Complicated parapneumonic pleural effusions are managed successfully in centres with experience in the different types of procedure that might be necessary&#46;</p><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009&#59; XV &#40;2&#41;&#58; 241-259</span></p></span>"
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Vol. 15. Issue 2.
Pages 241-259 (March - April 2009)
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Vol. 15. Issue 2.
Pages 241-259 (March - April 2009)
Artigo Original/Original Article
Open Access
Derrames pleurais parapneumónicos em pediatria: Experiência num hospital central universitário
Pediatric parapneumonic pleural effusions: Experience in a university central hospital
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Paulo Soares1,
Corresponding author
paulojosoares@sapo.pt

Correspondência / Correspondence to: Paulo Jorge Oliveira Soares, Hospital São João – UAG da Mulher e da Criança, Alameda Prof. Hernâni Monteiro. 4200-319 Porto Telefone: 225 512 100
, João Barreira2, Susana Pissarra2, Teresa Nunes3, Inês Azevedo3, Luísa Vaz4
1 Interno Complementar de Pediatria, Hospital de São João,Unidade Funcional de Pneumologia Pediátrica (Responsável: Dra. Luísa Vaz) / Resident, Paediatrics
2 Assistente Hospitalar de Pediatria, Hospital de São João,Unidade Funcional de Pneumologia Pediátrica (Responsável: Dra. Luísa Vaz) / Consultant, Paediatrics
3 Assistente Hospitalar Graduado de Pediatria, Hospital de São JoãoUnidade Funcional de Pneumologia Pediátrica (Responsável: Dra. Luísa Vaz) / Consultant, Paediatrics specialist
4 Chefe de Serviço Hospital de São JoãoUnidade Funcional de Pneumologia Pediátrica (Responsável: Dra. Luísa Vaz) / Unit Head
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Resumo

Introdução: Os derrames pleurais podem complicar as pneumonias na população pediátrica. Assumem especial importância pelas implicações na duração do internamento, geralmente prolongado, e pela morbilidade associada.

Objectivos: Caracterizar uma população de doentes com pneumonia complicada de derrame; determinar os possíveis factores de prognóstico a partir de dados clínicos, radiológicos e analíticos na admissão; e avaliar a influência das intervenções terapêuticas na evolução da doença.

Métodos: Revisão casuística dos doentes com idade inferior a 18 anos e derrame pleural parapneu mónico, internados de Julho de 1997 a Junho de 2004 (7 anos).

Resultados: Foram estudados 118 casos, 60% do sexo masculino, com idade média 7 anos. A incidência de derrame pleural aumentou ao longo do período do estudo. Verificou-se maior incidência de casos no Outono e no Inverno. Na admissão, 60% dos doentes apresentavam sinais de dificuldade respiratória e 39% dor torácica. Em 40% dos doentes foram detectados septos pleurais na admissão, o que se associou a maior duração de internamento e de antibioticoterapia e mais frequente necessidade de cirurgia. Em 72% dos doentes foi efectuada toracocentese (pH médio: 7,24). Em 17% foi possível isolar o agente: Streptococcus pneumoniae (cinco), Staphylococcus aureus (quatro) e Streptococcus pyogenes (quatro). Foram submetidos a drenagem pleural 52% e necessitaram de cirurgia 18%. A mediana da duração de internamento foi de 15 dias e a média de 16,4 dias (2 a 51).

Discussão: Associam-se a pior prognóstico a presença de: sinais de dificuldade respiratória; septos; empiema; baixo valor no líquido pleural de pH, glicose ou proteínas; desidrogenase láctica elevada no líquido pleural e proteína C-reactiva sanguínea aumentada. A drenagem pleural e/ou cirurgia mais precoces provavelmente diminuem o tempo de doença e de internamento.

Conclusão: Os derrames parapneumónicos complicados são tratados com êxito em centros de referência com experiência nos diferentes tipos de intervenção que poderão ser necessários.

Rev Port Pneumol 2009; XV (2): 241-259

Palavras-chave:
Pneumonia
derrame pleural
drenagem
cirurgia
prognóstico
Abstract

Introduction: Pleural effusions can complicate pneumonias in children and adolescents and are usually associated with a long hospital stay and increased morbidity.

Aims: To characterise a population of patients with parapneumonic pleural effusion and to establish possible prognostic factors on admission based on clinical, imaging and analytical data. To correlate treatment options with the outcome.

Methods: Case review of patients under 18 years old with parapneumonic pleural effusion, admitted between July 1997 – June 2004 (7years).

Results: 118 patients were included, 60% male, with mean age 7 years. The incidence of pleural effusion increased throughout the period of the study. The admissions occurred predominantly in autumn and winter. On admission 60% of patients had respiratory distress and 39% chest pain. In 40% loculations were found on admission and were associated with longer hospital stay, longer course of antibiotic therapy and more frequent need for surgery. Thoracentesis was performed in 72% of patients (mean pH pleural fluid 7.24). The aetiologic agent was identified in 17% of cases: Streptococcus pneumoniae (five), Staphylococcus aureus (four) and Streptococcus pyogenes (four). In our study, 52% of patients underwent pleural drainage and 18% surgery. Median length of hospital stay was 15 days with mean 16.4days (2 – 51).

Discussion: Factors associated with worse prognosis were respiratory distress, loculations, empyema, low pH in pleural fluid, glucose or proteins in pleural fluid, high lactic dehydrogenase level in pleural fluid and high serum C-reactive protein. Pleural drainage and/or surgery can shorten hospital stay and improve outcome.

Conclusion: Complicated parapneumonic pleural effusions are managed successfully in centres with experience in the different types of procedure that might be necessary.

Rev Port Pneumol 2009; XV (2): 241-259

Key-words:
Drainage
pleural effusion
pneumonia
prognosis
surgery
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