Journal Information
Vol. 15. Issue 2.
Pages 241-259 (March - April 2009)
Share
Share
Download PDF
More article options
Vol. 15. Issue 2.
Pages 241-259 (March - April 2009)
Full text access
Pediatric parapneumonic pleural effusions: Experience in a university central hospital
Derrames pleurais parapneumónicos em pediatria: Experiência num hospital central universitário
Visits
1007
Paulo Soares1,
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.
, João Barreira2, Susana Pissarra2, Teresa Nunes3, Inês Azevedo3, Luísa Vaz4,5, Doutor Caldas Afonso6
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
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
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 (7 years).

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 16.4 days (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.

Key-words:
Drainage
pleural effusion
pneumonia
prognosis
surgery
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 parapneumónico, 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.

Palavras-chave:
Pneumonia
derrame pleural
drenagem
cirurgia
prognóstico
Full text is only aviable in PDF
Bibliography/Bibliografia
[1.]
K. McIntosh.
Community-acquired pneumonia in children.
N Engl J Med, 346 (2002), pp. 429-437
[2.]
O.A. Cruz, B. González, M. Galdó, J.P. Frías, A.S. Posadas, L.S. Borrell, et al.
Tratamiento de los derrames pleurales parapneumónicos.
An Esp Pediatr, 54 (2001), pp. 272-282
[3.]
Cruz OA, Galdó AM, García MB. Derrame pleural parapneumónico (protocolos diagnósticos y terapéuticos en Pediatría) 2003. Acessível em http://www.aeped.es/protocolos a 30/01/2007.
[4.]
I.B. Lança, M. Santos, D. Barata, C.A. Vasconcelos.
Abordagem terapêutica dos derrames parapneumónicos e empiemas.
Acta Pediatr Port, 31 (2000), pp. 235-240
[5.]
M. Cohen, S.A. Sahn.
Resolution of pleural effusions.
Chest, 119 (2001), pp. 1547-1562
[6.]
C. Thumerelle, C. Santos, S. Morillon, L. Bott, G. Pouessel, A. Deschildre.
Facteurs de risqué de survenue des pleuropneumopathies bactériennes en pédiatrie.
Arch Pédiatr, 12 (2005), pp. 827-829
[7.]
O. Efrati, A. Barak.
Pleural effusions in the pediatric population.
Pediatr Rev, 23 (2002), pp. 417-426
[8.]
C. Durand, C. Garel, F. Nugues, P. Baudain.
L’échographie dans la pathologie thoracique de l’enfant.
J Radiol, 82 (2001), pp. 729-737
[9.]
B.L. Chen, J.C. Langer, P.A. Dillon, R.P. Foglia, C.B. Huddleston, E.N. Mendeloff, et al.
Management of late-stage parapneumonic empyema.
J Pediatr Surg, 37 (2002), pp. 371-374
[10.]
A. Thompson, A. Reid, M. Shields, H. Steen, R. Taylor.
Increased incidence in childhood empyema thoracis in Northern Ireland.
Ir Med J, 92 (1999), pp. 438
[11.]
W. Chan, E. Keiser-Gauvin, G.M. Davis, L.T. Nguyen, J.M. Laberge.
Empyema thoracis in children: a 26-year review of the Montreal Children's Hospital experience.
J Pediatr Surg, 32 (1997), pp. 870-872
[12.]
K.D. Schultz, L.L. Fan, J. Pinsky, L. Ochoa, E.O. Smith, S.L. Kaplan, et al.
The changing face of pleural empyemas in children: epidemiology and management.
Pediatrics, 113 (2004), pp. 1735-1740
[13.]
J.J. Doski, D. Lou, B.A. Hicks, S.M. Megison, P. Sanchez, M. Contidor, et al.
Management of parapneumonic collections in infants and children.
J Pediatr Surg, 35 (2000), pp. 265-270
[14.]
J.D. Campbell, J.P. Nataro, empyema. Pleural.
Pediatr Infect Dis J, 18 (1999), pp. 725-726
[15.]
M. Ostapchuk, D.M. Roberts, R. Haddy.
Community- acquired pneumonia in infants and children.
Am Fam Physician, 70 (2004), pp. 899-908
[16.]
E. Bodart, D. Weynants, G. de Bilderling, P. Eucher, D. Tuerlinckx.
Pleural effusion in childhood: management algorithm.
Rev Med Liege, 61 (2006), pp. 16-22
[17.]
R.W. Light.
Parapneumonic effusions empyema.
Proc Am Thorac Soc, 3 (2006), pp. 75-80
[18.]
H. Hamm.
The treatment of parapneumonic effusions and pleural empyemas.
Pneumologie, 59 (2005), pp. 696-703
[19.]
L. Shi-ping, L. Hui-ping.
Video-assisted thoracic surgery – the past, present status and the future.
J Zhejiang Univ, 7 (2006), pp. 118-128
[20.]
R. Subramaniam, V.T. Joseph, G.M. Tan, A. Goh, O.M. Chay.
Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children.
J Pediatr Surg, 36 (2001), pp. 316-319
Copyright © 2009. Sociedade Portuguesa de Pneumologia
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?