title: Echo-guided management of complicated parapneumonic effusion in children.
abstract: The optimal management of parapneumonic effusion and empyema in children remains controversial; currently there is insufficient evidence to give clear guidance on therapy. The aims of this study were to delineate the biochemical characteristics and to examine the effect of different therapeutic strategies on ultrasound staging of parapneumonic effusion. The ultrasonic appearances were classified according to the deposition of fibrin or formation of fibrin septations. A total of 81 patients were enrolled in the present study. Chest ultrasound was performed and results were stratified into anechoic fluid (stage 1, n = 23), with floating fibrin strands (stage 2, n = 30), and with septated fibrin (stage 3, n = 28). The mean days of fever elapsed before detection of these stages appeared to be higher at advanced stages (7.3 +/- 2.1 vs. 8.5 +/- 2.7 vs. 9.7 +/- 4.2, respectively; P = 0.03). Univariate analysis revealed that WBC, platelet count in hemogram and pH, glucose, protein, LDH in pleural effusion were significantly associated with the stages of parapneumonic effusion. Multivariate logistic analysis revealed that pH (less than 7.27) in pleural fluid was the only significant factor for the formation of fibrin with/without fibrin septations. The rate of successful tube drainage decreased as the advancement of stages of parapneumonic effusion, especially in patients using chest tube for drainage initially (P = 0.001). Total duration of fever and hospital stay was significantly shorter for those children who had initial video-assisted thoracic surgery (VATS) compared to those who had initial chest tube drainage (P < 0.001). Chest sonography can well discriminate the progressive stages of bacterial parapneumonic effusion. In children with a progressive parapneumonic effusion with fibrin formation, early aggressive tube drainage may avoid a subsequent surgical intervention. In children with a fibrin septated parapneumonic effusion, an initial VATS is recommended to shorten the duration of fever and hospital stay.
authors.affiliation: Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Chiu
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Shen-Hao
authors.initials: SH
authors.lastname: Lai
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D010976:Platelet Count; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014463:Ultrasonography
chemical_list: D005947:Glucose