Early decortication for postpneumonic empyema in children. Effect on pulmonary perfusion.
Early pulmonary decortication was performed on 66 of 137 children with postpneumonic empyema, while 71 received conventional treatment. The mean age of the 66 patients with decortication was 5.5 years (range 6 months-14 years). The empyema was left-sided in 34 and right-sided in 32. Decortication was performed when lung expansion was not obtained after 10-12 days of intercostal tube drainage, antibiotic therapy (guided by sensitivity tests of pleural fluid) and pleural irrigation. Scintigraphy showed loss of pulmonary perfusion on the side of empyema to be 65% +/- SD 20 (25-98)% before decortication in the 23 tested patients. In ten of them the test was repeated after surgery and showed significant (p < 0.001) diminution of the perfusion defect, from 57 +/- 6.8 (25-84)% to 4 +/- 2.6 (0-8)%. The hospital stay was significantly (p < 0.001) shorter for the surgically treated than for the classically managed patients, viz. 19.5 +/- 4 (13-36) days vs 73.6 +/- 14 (34-110) days. Early decortication thus had beneficial effects on pulmonary perfusion and hospital stay.
Eren
N
N
Department of Thoracic and Cardiovascular Surgery, Dicle University, School of Medicine, Diyarbakir, Turkey.
Ozçelic
C
C
Ener
B K
BK
Ozgen
G
G
Solak
H
H
Balci
A E
AE
Tas
S
S
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000295:instrumentation; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010994:Pleura; D011008:Pneumococcal Infections / Q000188:drug therapy; D011014:Pneumonia / Q000150:complications*; D011552:Pseudomonas Infections / Q000188:drug therapy; D011652:Pulmonary Circulation; D011877:Radionuclide Imaging; D013203:Staphylococcal Infections / Q000188:drug therapy; D013668:Technetium Tc 99m Aggregated Albumin; D007507:Therapeutic Irrigation
D000900:Anti-Bacterial Agents; D013668:Technetium Tc 99m Aggregated Albumin