Evaluation of management of postpneumonic empyema thoracis in children

Abstract

Background Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children.
Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n= 11), chest tube drainage (n= 229), chest tube drainage with intrapleural fibrinolytic therapy (n =117), video-assisted thoracoscopic surgery (VATS) (n =35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n =94).
Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n = 10), atelectasis (n= 18), delayed expansion (n= 7), and need for reoperation (n= 2). Four patients died (1.21%), two of them  following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely.
Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy.

Keywords: decortication, empyema, fibrinolysis, thoracotomy