title: The controversial role of decortication in the management of pediatric empyema.
abstract: Open surgical procedures for pleural empyema remain controversial in children. The pediatric literature generally recommends a prolonged trial of antibiotics and closed tube thoracostomy drainage. We report a favorable experience with a selective approach to open drainage in 22 children, many of whom had an empyema already organizing at admission. Open drainage was considered in children whose conditions failed to improve after 3 to 5 days of therapy with antibiotics and closed drainage. The method of drainage was selected according to the pathologic phase of the empyema: five children with fibrinopurulent empyema were successfully managed by limited decortication, and 17 with organizing empyema received decortication. Clinical improvement was usually dramatic; most of the children became afebrile by postoperative day 3 and were discharged by postoperative day 10. There were no deaths. Three children (14%) had complications of postoperative air leak or infection. Streptococcus pneumoniae (5) and Hemophilus influenzae (3) were the most common single pathogens. The presence of anaerobic bacteria in 8 of 22 children (36%) was associated with rapid organization of the empyema and the need for decortication. Decortication procedures have a low risk and are effective in children with empyema. They should be considered as definitive therapy, rather than as a last resort.
authors.affiliation: Department of Surgery, University of New Mexico Hospital, Albuquerque 87106.
authors.forename: A M
authors.initials: AM
authors.lastname: Kosloske
authors.forename: K C
authors.initials: KC
authors.lastname: Cartwright
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D004653:Empyema / Q000601:surgery*; D005260:Female; D006192:Haemophilus Infections / Q000601:surgery; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D010994:Pleura / Q000601:surgery; D011008:Pneumococcal Infections / Q000601:surgery; D013908:Thoracotomy