Conservative use of chest-tube insertion in children with pleural effusion.
The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.
Pediatric Pulmonology and INSERM U719, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, 26 avenue Arnold Netter, 75012, Paris, France. ralph.epaud@trs.ap-hop-paris.fr
R
R
Epaud
G
G
Aubertin
M
M
Larroquet
H Ducou-le
HD
Pointe
P
P
Helardot
A
A
Clement
B
B
Fauroux
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015505:Chest Tubes / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D016724:Empyema, Pleural / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010996:Pleural Effusion / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013995:Time; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents