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Baranov AA, Kozlov RS, Namazova-Baranova LS, Andreeva IV, Bakradze MD, Vishneva EA, Karaseva MS, Kuznetsova TA, Kulichenko TV, Lashkova YS, Lyutina EI, Manerov FK, Mayanskiy NA, Platonova MM, Polyakova AS, Selimzyanova LR, Tatochenko VK, Starovoytova EV, Stetsiouk OU, Fedoseenko MV, Chashchina IL, Kharkin AV. Modern approaches at the management of children with community-acquired pneumonia. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v20i1.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Experts of The Union of Pediatricians of Russia have developed current clinical guidelines for management of children with community-acquired pneumonia, which were approved by the Scientific and Practice Council of Ministry of Public Health of the Russian Federation in January 2022. Particular attention is paid to the etiological structure, modern classification, diagnostic tests and flagship approaches to antibacterial therapy of community-acquired pneumonia in children based on the principles of evidentiary medicine.
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Affiliation(s)
- Aleksander A. Baranov
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | - Elena A. Vishneva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | - Mariya S. Karaseva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - Yulia S. Lashkova
- Pirogov Russian National Research Medical University;
National Medical Research Center of Children’s Health
| | | | | | | | - Mariya M. Platonova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Lilia R. Selimzyanova
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | | | - Marina V. Fedoseenko
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
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2
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Moral L, Reyes S, Toral T, Ballesta A, Cervantes E. Management of parapneumonic pleural effusion and empyema in children: A tale of two cities. Pediatr Pulmonol 2022; 57:2546-2548. [PMID: 35775113 DOI: 10.1002/ppul.26055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/15/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Luis Moral
- Pediatric Respiratory and Allergy Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Susana Reyes
- Pediatric Intensive Care Unit, Virgen de la Arrixaca Clinical University Hospital, Murcia, Spain
| | - Teresa Toral
- Pediatric Respiratory and Allergy Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Amalia Ballesta
- Pediatric Intensive Care Unit, Virgen de la Arrixaca Clinical University Hospital, Murcia, Spain
| | - Eloísa Cervantes
- Pediatric Infectious Diseases Unit, Virgen de la Arrixaca Clinical University Hospital, Murcia, Spain
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3
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Moral L, Toral T, Clavijo A, Caballero M, Canals F, Forniés MJ, Moral J, Revert R, Lucas R, Huertas AM, González MC, García-Avilés B, Belda M, Marco N. Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage. Front Pediatr 2021; 9:621943. [PMID: 34368022 PMCID: PMC8335639 DOI: 10.3389/fped.2021.621943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD). Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018. Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721). Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.
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Affiliation(s)
- Luis Moral
- Pediatric Respiratory and Allergy Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Teresa Toral
- Pediatric Respiratory and Allergy Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Agustín Clavijo
- Department of Pediatrics, Marina Baixa Hospital, Villajoyosa, Spain
| | - María Caballero
- Department of Pediatrics, Vinalopó University Hospital, Elche, Spain
| | - Francisco Canals
- Department of Pediatrics, Elche University General Hospital, Elche, Spain
| | - María José Forniés
- Department of Pediatrics, Virgen de la Salud University General Hospital, Elda, Spain
| | - Jorge Moral
- Faculty of Medicine, Miguel Hernández University, Sant Joan d'Alacant, Spain
| | - Raquel Revert
- Department of Pediatrics, Alicante University General Hospital, Alicante, Spain
| | - Raquel Lucas
- Department of Pediatrics, Marina Salud Hospital, Denia, Spain
| | - Ana María Huertas
- Department of Pediatrics, Vinalopó University Hospital, Elche, Spain
| | | | - Belén García-Avilés
- Department of Pediatrics, Sant Joan d'Alacant University Clinical Hospital, Sant Joan d'Alacant, Spain
| | - Mónica Belda
- Department of Pediatrics, Virgen de los Lirios Hospital, Alcoy, Spain
| | - Nuria Marco
- Department of Pediatrics, Vega Baja Hospital, Orihuela, Spain
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Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J Clin Med 2019; 8:jcm8050698. [PMID: 31100958 PMCID: PMC6572435 DOI: 10.3390/jcm8050698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023] Open
Abstract
Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.
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5
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Díaz-Conradi A, Hernández S, García-García JJ, Muñoz-Almagro C, Moraga-Llop F, Ciruela P, Izquierdo C, Campins M, de Sevilla MF, González-Peris S, Uriona S, Martínez-Osorio J, Solé-Ribalta A, Codina G, Esteva C, Planes AM, Soldevila N, Salleras L, Domínguez A. Complicated pneumococcal pneumonia with pleural effusion or empyema in the 13-valent pneumococcal conjugate vaccine era. Pediatr Pulmonol 2019; 54:517-524. [PMID: 30784235 DOI: 10.1002/ppul.24279] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/09/2019] [Indexed: 11/06/2022]
Abstract
AIM The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015. RESULTS We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10-5 persons/year in cases with PE or empyema and 2.09 cases × 10-5 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054). CONCLUSIONS A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant reduction in PCV13 serotypes, especially serotype 1, coinciding with increased PCV13 coverage.
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Affiliation(s)
| | - Sergi Hernández
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Pilar Ciruela
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Conchita Izquierdo
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Nuria Soldevila
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Luis Salleras
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Angela Domínguez
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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Pereira RR, Alvim CG, Andrade CRD, Ibiapina CDC. Parapneumonic pleural effusion: early versus late thoracoscopy. ACTA ACUST UNITED AC 2017; 43:344-350. [PMID: 28767771 PMCID: PMC5790662 DOI: 10.1590/s1806-37562016000000261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/26/2017] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.
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Affiliation(s)
- Rodrigo Romualdo Pereira
- . Hospital da Previdência, Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG - Belo Horizonte (MG) Brasil
| | - Cristina Gonçalves Alvim
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Cláudia Ribeiro de Andrade
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | - Cássio da Cunha Ibiapina
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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7
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Segerer FJ, Seeger K, Maier A, Hagemann C, Schoen C, van der Linden M, Streng A, Rose MA, Liese JG. Therapy of 645 children with parapneumonic effusion and empyema-A German nationwide surveillance study. Pediatr Pulmonol 2017; 52:540-547. [PMID: 27648553 PMCID: PMC5396379 DOI: 10.1002/ppul.23562] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 08/06/2016] [Accepted: 08/10/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the initial management of pediatric parapneumonic effusion or pleural empyema (PPE/PE) with regard to length of hospital stay (LOS). METHODS Collection of pediatric PPE/PE cases using a nationwide surveillance system (ESPED) from 10/2010 to 06/2013, in all German pediatric hospitals. Inclusion of PPE/PE patients <18 years of age requiring drainage or with a PPE/PE persistence >7 days. Staging of PPE/PE based on reported pleural sonographic imaging. Comparison of LOS after diagnosis between children treated with different forms of initial invasive procedures performed ≤3 days after PPE/PE diagnosis: pleural puncture, draining catheter, intrapleural fibrinolytic therapy, surgical procedures. RESULTS Inclusion of 645 children (median age 5 years); median total LOS 17 days. Initial therapy was non-invasive in 282 (45%) cases and invasive in 347 (55%) cases (pleural puncture: 62 [10%], draining catheter: 153 [24%], intrapleural fibrinolytic therapy: 89 [14%], surgical procedures: 43 [7%]). LOS after diagnosis did not differ between children initially treated with different invasive procedures. Results remained unchanged when controlling for sonographic stage, preexisting diseases, and other potential confounders. Repeated use of invasive procedures was observed more often after initial non-invasive treatment or pleural puncture alone than after initial pleural drainage, intrapleural fibrinolytic therapy or surgery. CONCLUSIONS Initial treatment with intrapleural fibrinolytic therapy or surgical procedures did not result in shorter LOS than initial pleural puncture alone. Larger prospective studies are required to investigate which children benefit significantly from more intensive forms of initial invasive treatment. Pediatr Pulmonol. 2017;52:540-547. © 2016 The Authors. Pediatric Pulmonology Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Karin Seeger
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Anna Maier
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | | | - Christoph Schoen
- Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Mark van der Linden
- Department of Medical Microbiology, National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
| | - Andrea Streng
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Markus A Rose
- Children's Hospital, Goethe University of Frankfurt, Frankfurt, Germany
| | - Johannes G Liese
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
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8
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Richards MK, Mcateer JP, Edwards TC, Hoffman LR, Kronman MP, Shaw DW, Goldin AB. Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema. Surg Infect (Larchmt) 2016; 18:137-142. [PMID: 27898253 DOI: 10.1089/sur.2016.134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite six randomized trials of various treatments for pediatric para-pneumonic effusion (PPE), management approaches differ. The purpose of this study was to gain insight into opinions on PPE treatment with the goal of designing a definitive trial to generate consensus intervention guidelines. METHODS To evaluate physician opinions regarding PPE management, we developed a survey based on input from a nationwide, multi-disciplinary advisory group that established content validity. The survey was disseminated broadly to six pediatric medicine and interventional radiology groups. Descriptive and χ2 statistics were calculated. RESULTS There were 741 respondents (response rate 13.1%), of whom 52.2% were surgeons, 15.2% hospitalists, 14.2% pulmonologists, 12.4% intensivists, and 6.0% interventional radiologists. Nearly all respondents (97.3%) reported caring primarily for pediatric patients. Eighty percent reported no written institutional treatment guidelines. Nearly all (90.3%) agreed that patients require antibiotics, but there was disagreement regarding their duration. Respondents also were split as to how often PPE required drainage. There were multiple absolute indications for drainage, including mediastinal shift on chest radiograph (67.2%) and loculations on imaging (47.7%). There were substantial differences in the preferred first-line methods of drainage based on the treating physician's specialty, with surgeons preferring tube thoracostomy and a fibrinolytic agent (42.0%) or video-assisted thoracoscopic surgery (41.6%), whereas interventional radiologists preferred either a tube thoracostomy (46.4%) or a tube thoracostomy with a fibrinolytic agent (39.3%) (p < 0.001). A large majority (75.3%) believed that the published evidence does not identify the optimal intervention. CONCLUSIONS There is a lack of consensus regarding the optimal treatment of PPE. Respondents believed the published evidence is inconclusive and were willing to participate in a prospective trial. These findings will help inform the design of a randomized, pragmatic clinical trial to optimize PPE management.
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Affiliation(s)
- Morgan K Richards
- 1 Department of Surgery, University of Washington , Seattle, Washington
| | - Jarod P Mcateer
- 1 Department of Surgery, University of Washington , Seattle, Washington
| | - Todd C Edwards
- 2 Department of Health Services, University of Washington , Seattle, Washington
| | - Lucas R Hoffman
- 3 Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital , Seattle
| | - Matthew P Kronman
- 4 Department of Pediatrics, Division of Infectious Disease, Seattle Children's Hospital , Seattle
| | - Dennis W Shaw
- 5 Department of Radiology, Seattle Children's Hospital
| | - Adam B Goldin
- 6 Department of Thoracic and General Surgery, Seattle Children's Hospital
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9
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Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, Melfi F, Schmid RA, Athanassiadi K, Sousa Uva M, Cardillo G. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg 2015; 48:642-53. [PMID: 26254467 DOI: 10.1093/ejcts/ezv272] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Scarci
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Piergiorgio Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Aravinda Page
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Franca Melfi
- Department of Cardiothoracic Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Berne University Hospital, Berne, Switzerland
| | | | - Miguel Sousa Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Az. Osped. S. Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy
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10
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Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25-76. [PMID: 21880587 PMCID: PMC7107838 DOI: 10.1093/cid/cir531] [Citation(s) in RCA: 991] [Impact Index Per Article: 76.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/08/2011] [Indexed: 02/07/2023] Open
Abstract
Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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Affiliation(s)
- John S Bradley
- Department of Pediatrics, University of California San Diego School of Medicine and Rady Children's Hospital of San Diego, San Diego, California, USA.
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11
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Scarci M, Zahid I, Billé A, Routledge T. Is video-assisted thoracoscopic surgery the best treatment for paediatric pleural empyema? Interact Cardiovasc Thorac Surg 2011; 13:70-6. [PMID: 21454312 DOI: 10.1510/icvts.2010.254698] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether video-assisted thoracic surgery (VATS) is the best treatment for paediatric pleural empyema. Altogether 274 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that early VATS (or thoracotomy if VATS not possible) leads to shorter hospitalisation. The duration of chest tube placement and antibiotic use is variable and does not correlate with treatment method. Patients who underwent primary operative therapy had a lower aggregate in-hospital mortality rate (0% vs. 3.3%), re-intervention rate (2.5% vs. 23.5%), length of stay (10.8 days vs. 20.0 days), duration of tube thoracostomy (4.4 days vs. 10.6 days), and duration of antibiotic therapy (12.8 days vs. 21.3 days), compared with patients who underwent non-operative therapy. Similar complication rates were observed for the two groups (5% vs. 5.6%). Moreover, median hospital charges for VATS were $36,320 [interquartile range (IQR), $24,814-$62,269]. The median pharmacy and radiological imaging charges were $5884 (IQR, $3142-$11,357) and $2875 (IQR, $1703-$4950), respectively, for VATS and tube drainage. Adjusting for propensity score matching, costs for primary VATS were equivalent to primary chest tube placement. Only one article found discordant results. Ninety-five children (52%) received antibiotics alone, and 87 (45%) underwent drainage procedures (21 chest tube alone, 57 VATS/thoracotomy, and eight chest tube followed by VATS/thoracotomy); only four received fibrinolytics. Mean (standard deviation) length of stay was significantly shorter in the antibiotics alone group, 7.0 (3.5) days vs. 11 (4.0) days. The strongest predictors of undergoing pleural drainage were admission to the intensive care unit and large effusion size (>1/2 thorax filled).
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Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
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