Pediatric parapneumonic pleural effusions: Experience in a university central hospital
Derrames pleurais parapneumónicos em pediatria: Experiência num hospital central universitário
Paulo Soares1,
, João Barreira2, Susana Pissarra2, Teresa Nunes3, Inês Azevedo3, Luísa Vaz4,5, Doutor Caldas Afonso6
Corresponding author
paulojosoares@sapo.pt
Correspondence to/Correspondência: Hospital São João – UAG da Mulher e da Criança, Alameda Prof. Hernâni Monteiro. 4200-319 Porto. Telefone: 225 512 100.
Correspondence to/Correspondência: Hospital São João – UAG da Mulher e da Criança, Alameda Prof. Hernâni Monteiro. 4200-319 Porto. Telefone: 225 512 100.
1 Interno Complementar de Pediatria / Resident, Paediatrics
2 Assistente Hospitalar de Pediatria / Consultant, Paediatrics
3 Assistente Hospitalar Graduado de Pediatria / Consultant, Paediatrics specialist
4 Chefe de Serviço / Unit Head
5 Hospital de São João, Unidade Funcional de Pneumologia Pediátrica
6 Hospital de São João, Serviço de Pediatria
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array:3 [ "entidad" => "Hospital de São João, Unidade Funcional de Pneumologia Pediátrica" "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital de São João, Serviço de Pediatria" "etiqueta" => "<span class="elsevierStyleSup">6</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Hospital São João – UAG da Mulher e da Criança, Alameda Prof. Hernâni Monteiro. 4200-319 Porto. Telefone: 225 512 100." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Derrames pleurais parapneumónicos em pediatria: Experiência num hospital central universitário" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-06-13" "fechaAceptado" => "2008-11-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159997" "palabras" => array:5 [ 0 => "Drainage" 1 => "pleural effusion" 2 => "pneumonia" 3 => "prognosis" 4 => "surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159996" "palabras" => array:5 [ 0 => "Pneumonia" 1 => "derrame pleural" 2 => "drenagem" 3 => "cirurgia" 4 => "prognóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pleural effusions can complicate pneumonias in children and adolescents and are usually associated with a long hospital stay and increased morbidity.</p> <span class="elsevierStyleSectionTitle">Aims</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Case review of patients under 18 years old with parapneumonic pleural effusion, admitted between July 1997 – June 2004 (7 years).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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: <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> (five), <span class="elsevierStyleItalic">Staphylococcus aureus</span> (four) and <span class="elsevierStyleItalic">Streptococcus pyogenes</span> (four). In our study, 52% of patients underwent pleural drainage and 18% surgery. Median length of hospital stay was 15 days with mean 16.4 days (2 – 51).</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Complicated parapneumonic pleural effusions are managed successfully in centres with experience in the different types of procedure that might be necessary.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revisão casuística dos doentes com idade inferior a 18 anos e derrame pleural parapneumónico, internados de Julho de 1997 a Junho de 2004 (7 anos).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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: <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> (cinco), <span class="elsevierStyleItalic">Staphylococcus aureus</span> (quatro) e <span class="elsevierStyleItalic">Streptococcus pyogenes</span> (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).</p> <span class="elsevierStyleSectionTitle">Discussão</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os derrames parapneumónicos complicados são tratados com êxito em centros de referência com experiência nos diferentes tipos de intervenção que poderão ser necessários.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Community-acquired pneumonia in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. 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| Year/Month | Html | Total | |
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