Management of postpneumonic empyemas in children

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dc.contributor.authorOzcelik, C
dc.contributor.authorÜlkü, R
dc.contributor.authorOnat, S
dc.contributor.authorOzcelik, Z
dc.contributor.authorInci, I
dc.contributor.authorSatici, O
dc.date.accessioned2024-04-24T16:11:19Z
dc.date.available2024-04-24T16:11:19Z
dc.date.issued2004
dc.departmentDicle Üniversitesien_US
dc.description.abstractObjectives: Despite continued improvement in medical therapy, pediatric empyema remains a challenging problem for the surgeon. Multiple treatment options are available; however, the optimal therapeutic management has not been elucidated. The aim of this study is to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: A retrospective review was performed of pediatric patients admitted to Dicle University School of Medicine Thoracic and Cardiovascular Surgery Department between 1990 and 2002, with the diagnosis of empyema. Data tabulated included patient demographics, presentation, treatment and outcome. Results: There were 515 children (289 boys and 226 girls) with a mean age of 4.7 ranging from 18 days to 15 years. Empyema was secondary to pneumonia in all children. The most common radiologic finding was pleural effusion in 285 patients (55.32%). Staphylococcus aureus was the most frequently encountered organism and found in 105 patients (20.38%). Pleural fluid cultures were negative in 195 patients (37.86%). In addition to antibiotic therapy, initial treatment included serial thoracenthesis (n = 29), chest tube drainage alone (n = 214), chest tube drainage with intrapleural fibrinolytic therapy (n = 72), chest tube drainage with primary operation (n = 191), and primary operation without chest tube drainage (n = 9). Overall response rate with fibrinolytic treatment (complete and partial response) was obtained in 58 patients. In addition to decortication pulmonary resections were performed in 12 patients. Overall mortality rate was 1.55%. There was no operative mortality. Postoperative morbidity included wound infection in 21, delayed expansion in 8, and atelectasis in 35 patients. Conclusions: Multiple therapeutic options are available for the management of pediatric empyema. Depending on stages, every option has a role in the treatment of postpneumonic pediatric empyema. In the absence of bronchopleural fistula, intrapleural fibrinolytic treatment should be tried in all patients with multiloculations in stage II empyema. In the absence of pneumonia, decortication for empyema is a safe approach with low mortality and morbidity rates. (C) 2003 Elsevier B.V. All rights reserved.en_US
dc.identifier.doi10.1016/j.ejcts.2003.12.025
dc.identifier.endpage1078en_US
dc.identifier.issn1010-7940
dc.identifier.issn1873-734X
dc.identifier.issue6en_US
dc.identifier.pmid15145012en_US
dc.identifier.scopus2-s2.0-2442604751en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1072en_US
dc.identifier.urihttps://doi.org/10.1016/j.ejcts.2003.12.025
dc.identifier.urihttps://hdl.handle.net/11468/15352
dc.identifier.volume25en_US
dc.identifier.wosWOS:000221996700036
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoenen_US
dc.publisherOxford Univ Press Incen_US
dc.relation.ispartofEuropean Journal of Cardio-Thoracic Surgeryen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectEmpyemaen_US
dc.subjectFibrinolytic Treatmenten_US
dc.subjectDecorticationen_US
dc.subjectPostpneumonicen_US
dc.titleManagement of postpneumonic empyemas in childrenen_US
dc.typeArticleen_US

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