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        "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&#46;</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&#44; imaging and analytical data&#46; To correlate treatment options with the outcome&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Case review of patients under 18 years old with parapneumonic pleural effusion&#44; admitted between July 1997 &#8211; June 2004 &#40;7 years&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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 days &#40;2 &#8211; 51&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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> <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&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revis&#227;o casu&#237;stica dos doentes com idade inferior a 18 anos e derrame pleural parapneum&#243;nico&#44; internados de Julho de 1997 a Junho de 2004 &#40;7 anos&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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>"
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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)
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Pediatric parapneumonic pleural effusions: Experience in a university central hospital
Derrames pleurais parapneumónicos em pediatria: Experiência num hospital central universitário
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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
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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
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