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Empyema Drainage

  • David Rea
Chapter

Abstract

Childhood empyema is an uncommon but serious complication of pneumonia occurring in one in 150 children hospitalized with pneumonia, affecting 3.3 per 100,000 children. Recent epidemiological data demonstrates an increased incidence of pneumonia in Europe and North America. The principal aims of empyema treatment are control of sepsis and restoration of normal pulmonary function to prevent lung trapping by fibrous pleural peel. The optimal treatment for childhood empyema remains a challenge as there are only a few well-powered randomized controlled trials comparing the variety of treatment options. Current therapeutic options include systemic intravenous antibiotics alone or in combination with thoracocentesis, chest drain insertion with or without instillation of fibrinolytics, and surgical treatments such as video-assisted thoracoscopic surgery (VATS) and thoracotomy.

Keywords

Drainage Catheter Pleural Space Chlorhexidine Gluconate Chest Ultrasound British Thoracic Society Guideline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Hardie W, Bokulic R, Garcia VF, Reising SF, Christie CD. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996;22(6):1057–63. PubMed PMID: 8783710.PubMedCrossRefGoogle Scholar
  2. 2.
    Eastham KM, Freeman R, Kearns AM, Eltringham G, Clark J, Leeming J, Spencer DA. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax. 2004;59(6):522–5. PubMed PMID: 15170039; PubMed Central PMCID: PMC1747032.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Schultz KD, Fan LL, Pinsky J, Ochoa L, Smith EO, Kaplan SL, Brandt ML. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics. 2004;113(6):1735–40. PubMed PMID: 15173499.PubMedCrossRefGoogle Scholar
  4. 4.
    Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, Spencer D, Thomson AH, Urquhart D. Pediatric pleural diseases subcommittee of the BTS standards of care committee. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60 Suppl 1:i1–21. PubMed PMID: 15681514; PubMed Central PMCID: PMC1766040.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Jaffé A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol. 2005;40(2):148–56. Review. PubMed PMID: 15965900.PubMedCrossRefGoogle Scholar
  6. 6.
    Russell-Taylor M. Bacterial pneumonias: management and complication. Paediatr Respir Rev. 2000;1(1):14–20. Review. PubMed PMID: 16263437.PubMedCrossRefGoogle Scholar
  7. 7.
    Sonnappa S, Cohen G, Owens CM, van Doorn C, Cairns J, Stanojevic S, Elliott MJ, Jaffé A. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174(2):221–7. Epub 2006 May 4. PubMed PMID: 16675783.PubMedCrossRefGoogle Scholar
  8. 8.
    St Peter SD, Tsao K, Spilde TL, Keckler SJ, Harrison C, Jackson MA, Sharp SW, Andrews WS, Rivard DC, Morello FP, Holcomb 3rd GW, Ostlie DJ. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106–11; discussion 111. Erratum in: J Pediatr Surg. 2009;44(9):1865. Rivard, Doug C [added]; Morello, Frank P [added]. PubMed PMID: 19159726.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 2009;39(6):527–37. Epub 2009 Feb 6. Review. PubMed PMID: 19198826.PubMedCrossRefGoogle Scholar
  10. 10.
    Ramnath RR, Heller RM, Ben-Ami T, Miller MA, Campbell P, Neblett 3rd WW, Holcomb GW, Hernanz-Schulman M. Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. 1998;101(1 Pt 1):68–71. PubMed PMID: 9417153.PubMedCrossRefGoogle Scholar
  11. 11.
    Shankar S, Gulati M, Kang M, Gupta S, Suri S. Image-guided percutaneous drainage of thoracic empyema: can sonography predict the outcome? Eur Radiol. 2000;10(3):495–9. PubMed PMID: 10757003.PubMedCrossRefGoogle Scholar
  12. 12.
    Jaffe A, Calder AD, Owens CM, Stanojevic S, Sonnappa S. Role of routine computed tomography in pediatric pleural empyema. Thorax. 2008;63(10):897–902. Epub 2008 May 20. PubMed PMID: 18492739.PubMedCrossRefGoogle Scholar
  13. 13.
    Lepor NE, Madyoon H. Antiseptic skin agents for percutaneous procedures. Rev Cardiovasc Med. 2009 Fall;10(4):187–93. Review. PubMed PMID: 20065928.Google Scholar
  14. 14.
    Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362(1): 18–26. PubMed PMID: 20054046.PubMedCrossRefGoogle Scholar
  15. 15.
    Upadhyayula S, Kambalapalli M, Harrison CJ. Safety of anti-infective agents for skin preparation in premature infants. Arch Dis Child. 2007;92(7):646–7. Review. PubMed PMID: 17588981; PubMed Central PMCID: PMC2083764.PubMedCrossRefGoogle Scholar
  16. 16.
    Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002;57(4):343–7. PubMed PMID: 11923554; PubMed Central PMCID: PMC1746300.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, Gabe R, Rees GL, Peto TE, Woodhead MA, Lane DJ, Darbyshire JH, Davies RJ, First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352(9):865–74. Erratum in: N Engl J Med. 2005;352(20):2146. PubMed PMID: 15745977.PubMedCrossRefGoogle Scholar
  18. 18.
    Keeling AN, Leong S, Logan PM, Lee MJ. Empyema effusion: outcome of image-guided small-bore catheter drainage. Cardiovasc Intervent Radiol. 2008;31(1):135–41. Epub 2007 Oct 18. PubMed PMID: 17943347.PubMedCrossRefGoogle Scholar
  19. 19.
    Macha DB, Thomas J, Nelson RC. Pigtail catheters used for percutaneous fluid drainage: comparison of performance characteristics. Radiology. 2006;238(3): 1057–63. PubMed PMID: 16505398.PubMedCrossRefGoogle Scholar
  20. 20.
    Hogan MJ, Coley BD. Interventional radiology treatment of empyema and lung abscesses. Paediatr Respir Rev. 2008;9(2):77–84; quiz 84. Epub 2008 May 12. Review. PubMed PMID: 18513667.PubMedCrossRefGoogle Scholar
  21. 21.
    McLaughlin FJ, Goldmann DA, Rosenbaum DM, Harris GB, Schuster SR, Strieder DJ. Empyema in children: clinical course and long-term follow-up. Pediatrics. 1984;73(5):587–93. PubMed PMID: 6718113.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of RadiologyOur Lady’s Children HospitalDublin 12Ireland

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