Complicated pleural effusion in children – Therapeutical approach
Derrame pleural complicado na criança – Abordagem terapêutica
Sara Martins1, Sandra Valente1, Teresa Nunes David2, Luísa Pereira2, Celeste Barreto3, Teresa Bandeira3,
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teresa.bandeira@hsm.min-saude.pt
Correspondence to/Correspondência: Unidade de Pneumologia Pediátrica (UPP), Clínica Universitária de Pediatria, Director de Serviço: Prof. Doutor J. Gomes Pedro, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 LISBOA.
Correspondence to/Correspondência: Unidade de Pneumologia Pediátrica (UPP), Clínica Universitária de Pediatria, Director de Serviço: Prof. Doutor J. Gomes Pedro, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 LISBOA.
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"referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Sandra" "apellidos" => "Valente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "Nunes David" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Luísa" "apellidos" => "Pereira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Celeste" "apellidos" => "Barreto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] ] ] 5 => array:4 [ "nombre" => "Teresa" "apellidos" => "Bandeira" "email" => array:1 [ 0 => "teresa.bandeira@hsm.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Interna de Internato Complementar de Pediatria / Resident of Paediatrics" "etiqueta" => "<span class="elsevierStyleSup">1.</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Assistente Hospitalar de Pediatria / Hospital Assistant, Paediatrics" "etiqueta" => "<span class="elsevierStyleSup">2.</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Assistente Hospitalar Graduada de Pediatria / Hospital Assistant, Consultant Paediatrics" "etiqueta" => "<span class="elsevierStyleSup">3.</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Unidade de Pneumologia Pediátrica (UPP), Clínica Universitária de Pediatria, Director de Serviço: Prof. Doutor J. Gomes Pedro, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 LISBOA." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Derrame pleural complicado na criança – Abordagem terapêutica" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-10-28" "fechaAceptado" => "2006-09-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec158978" "palabras" => array:3 [ 0 => "Pleural effusion" 1 => "pleural empyema" 2 => "child" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec158979" "palabras" => array:3 [ 0 => "Derrame pleural" 1 => "empiema pleural" 2 => "criança" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pediatric management of complicated pleural effusion (CPE) remains controversial. Different approaches include antibiotics and chest tube drainage alone or the use of fibrinolitics, videothorascoscopy (VTC) and surgical decortication through thoracotomy.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The aim of the present study was to review, evaluate and update technical approach to CPE. We retrospectively reviewed the clinical files of children admitted to the Pediatric Respiratory Ward between 1992 and 2003 with the diagnosis of CPE. Twenty-five patients were included [15 male (60%)]. Mean (±SD) age was 37,4 (±37,0) months. Bacteria were identified in 17/25 (68%) [<span class="elsevierStyleItalic">S. aureus</span> in 6/17 (35%), <span class="elsevierStyleItalic">St. pneumoniae</span> in 5/17 (29%)], 16/17 (94%)in the pleural fluid. Twenty-five children were treated with antibiotics and thoracocentesis (100%). Chest tube drainage was required in 22/25 (88%) with mean (±DP) duration of 14,2 (±7,8) days. Fibrinolitics were employed in 1 only case and surgical decortication in 11/25 (44%). One patient (4%) was submitted to primary VTC. Median length of stay was 30,4 (±15,1) days and no deaths were recorded. Center skills in CPE management are critical on the choice of the technique and the timing of approach. This seems to influence immediate prognosis.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A abordagem do derrame pleural parapneumónico complicado, em idade pediátrica, permanece controversa. As opções terapêuticas incluem antibioticoterapia e drenagem pleural contínua, instilação intrapleural de fibrinolíticos, videotoracoscopia e toracotomia com descorticação. O objectivo deste estudo foi rever, avaliar e actualizar a abordagem ao derrame pleural complicado. Procedeu-se à revisão retrospectiva dos processos clínicos das crianças internadas na UPP por derrame pleural complicado entre 1992 e 2003. Foram incluídos 25 doentes, com idade média (±DP): 37,4 (± 37,0) meses, sendo 15/25 (60%) do sexo masculino. A identificação do agente foi possível em 17/25 (68%) casos [<span class="elsevierStyleItalic">S. aureus</span> 6/17 (35%), <span class="elsevierStyleItalic">St. pneumoniae</span> 5/17 (29%)], no líquido pleural em 16/17 (94%) casos. Todos os doentes realizaram toracocentese e antibioticoterapia sistémica. A drenagem pleural contínua foi instituída em 22/25 (88%) casos com duração média (±DP): 14,2 (± 7,8) dias; em 1 caso houve instilação de fibrinolíticos intrapleurais e em 11/25 (44%) realizou-se toracotomia com descorticação. Um doente foi submetido a videotoracoscopia primária. A duração média de internamento (±DP) foi de 30,4 (± 15,1) dias e não ocorreram óbitos. A experiência do centro é determinante na abordagem escolhida e na rapidez de actuação. 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| Year/Month | Html | Total | |
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| 2024 November | 11 | 5 | 16 |
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