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parapneumonic effusion in pediatrics

Charles A James, Leah E Braswell, Amir H Pezeshkmehr, Paula K Roberson, James A Parks, Mary B Moore
BACKGROUND: Complicated pleural effusion prolongs the hospital course of pneumonia. Chest tube placement with instillation of fibrinolytic medication allows efficient drain output and decreases hospital stay. OBJECTIVE: To evaluate experience with lower fibrinolytic dose for parapneumonic effusions and to assess potential dose stratification based on a simple ultrasound grading system. MATERIALS AND METHODS: We retrospectively reviewed the medical record to identify children and young adults who received fibrinolytic therapy for parapneumonic effusion and had chest tube placement by an interventional radiology service at a single children's hospital...
October 5, 2016: Pediatric Radiology
Florian J Segerer, Karin Seeger, Anna Maier, Christine Hagemann, Christoph Schoen, Mark van der Linden, Andrea Streng, Markus A Rose, Johannes G Liese
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...
September 20, 2016: Pediatric Pulmonology
Jonathan Strutt, Anupam Kharbanda
Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined...
November 2015: Pediatric Emergency Medicine Practice
Gaudenz M Hafen, Andrea-Claudia Grenzbach, Alexander Moeller, Mascha K Rochat
Treatment of parapneumonic effusion in children remains controversial in the literature and in clinical practice. The aim of this study was to determine whether mutual consensus exists in the diagnosis and treatment of parapneumonic effusion in Central European countries. A questionnaire was sent to all directors of pediatric respiratory units in four adjacent Central European countries (Austria, France, Germany, Switzerland). The response rate was 61.8%. Responses reflected acceptable agreement regarding initial diagnostic procedures, as most centers performed chest X-ray and biological exams, followed by ultrasound, thoracocentesis, or computed tomography...
April 2016: Pediatric Pulmonology
Y-H Wu, G-W Zhao, X-F Wang, M-S Wang
OBJECTIVE: Pleural effusion (PE) adenosine deaminase (ADA) has good performance in detection of tuberculous pleural effusion (TPE). However, few study was conducted for its value in pediatric patients. To evaluate PE ADA in diagnosis of pediatric TPE, a retrospective study was performed. PATIENTS AND METHODS: 204 pediatric PE patients were enrolled, and then were grouped into TPE group (77 cases, aged 11.51 ± 0.40 years) and non-TPE group (127 cases, aged 6.39 ± 0...
2015: European Review for Medical and Pharmacological Sciences
Jessica L Taylor, Meixia Liu, David S Hoff
OBJECTIVES: Medical treatment of complicated parapneumonic effusion or empyema in pediatric patients includes antibiotics and pleural space drainage. Intrapleural fibrinolysis may facilitate pleural drainage; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in pediatric patients. Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy...
March 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Sheila J Hanson, Peter L Havens, Pippa M Simpson, Melodee L Nugent, Robert G Wells
OBJECTIVE: In this prospective, double-blind, randomized crossover trial, we determined the effect of intrapleural fibrinolysis with alteplase compared to that of normal saline irrigation on the thoracostomy tube output and pleural effusion volume in children with complicated parapneumonic effusion. METHODS: Twenty seven children, median age 3.5 years, referred to the interventional radiology service for thoracostomy tube drainage of a parapneumonic effusion were studied...
December 2015: Pediatric Pulmonology
Jeffrey M Pernica, Ioana Moldovan, Francis Chan, Robert Slinger
BACKGROUND: Community-acquired pneumonia (CAP) complicated by parapneumonic effusion/empyema is an infectious syndrome commonly encountered by physicians caring for children in Canada. OBJECTIVE: To investigate the incremental benefit of novel molecular testing for the microbiological diagnosis of pediatric CAP complicated by parapneumonic effusion/empyema in Canada. METHODS: A convenience sample of pleural fluid from 56 children who had been admitted to hospital in Ontario with CAP complicated by parapneumonic effusion between 2009 and 2011 was examined...
May 2014: Canadian Journal of Infectious Diseases & Medical Microbiology
Robert Slinger, Lucie Hyde, Ioana Moldovan, Francis Chan, Jeffrey M Pernica
BACKGROUND: To determine the serotypes of Streptococcus pneumoniae responsible for pneumonia complicated by parapneumonic effusion in children, we performed real-time PCR based pneumococcal "serotyping" directly on parapneumonic fluid samples. METHODS: Specimens were collected at two children's hospitals in Ontario, Canada from 2009 to 2011. Samples in which S. pneumoniae was detected by PCR were tested with serotype-specific 5'exonuclease PCR assays for the 13 serotypes contained in the 13-serotype pneumococcal vaccine...
2014: BMC Pediatrics
Francesca Reali, Giuseppe Francesco Sferrazza Papa, Paolo Carlucci, Paola Fracasso, Fabiano Di Marco, Marzia Mandelli, Simone Soldi, Enrica Riva, Stefano Centanni
BACKGROUND: Lung ultrasound is a non-radiating accurate alternative tool to chest X-ray (CXR) in the diagnosis of community-acquired pneumonia (CAP) in adults. OBJECTIVES: The aim of our study was to define the accuracy of ultrasound in the diagnosis of CAP in children. METHODS: 107 consecutive children with suspected CAP underwent clinical examination, blood sample analysis, CXR and lung ultrasound on admission to the Pediatric Department of the San Paolo Hospital...
2014: Respiration; International Review of Thoracic Diseases
G Di Napoli, M Ronzini, G Paradies
Pneumonia is a common cause of pediatric hospitalization and almost 50% of children hospitalized for pneumonia develops meta pneumonic pleural effusion, most of which resolve spontaneously (1). The meta pneumonic effusion remains a major source of morbidity and mortality in the pediatric population and is a complication on the rise in both the U.S. (2) and Europe (3-6). There is no uniformity of treatment of the meta pneumonic effusion in its early stages and are still questioning some aspects of proper management, remains uncertain and not always shared the operative timing (7)...
May 2014: Il Giornale di Chirurgia
A Le Mée, C Mordacq, M Lagrée, A Deschildre, A Martinot, F Dubos
AIM: This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. METHODS: A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course...
September 2014: Acta Paediatrica
Kalliopi Kontouli, Elpis Hatziagorou, Fotis Kyrvasilis, Emmanuel Roilides, Maria Emporiadou, John Tsanakas
OBJECTIVES: a: To evaluate the long-term outcome of parapneumonic effusions (PPE) in children regarding lung function and exercise tolerance, (b) to investigate the role of bronchial asthma in the outcome of PPE. METHODS: The design of the study included 51 children with PPE, at least 2 years after the initial infection. They were divided in two groups. Group A (38 children) consisted of children with PPE but without asthma prior initial infection. Group B (13 children) included children with PPE and asthma prior infection...
June 2015: Pediatric Pulmonology
Koen Huysentruyt, Philippe Alliet, Marc Raes, Julie Willekens, Iris De Schutter, Elke De Wachter, Anne Malfroot, Thierry Devreker, Philippe Goyens, Yvan Vandenplas, Jean De Schepper
BACKGROUND & AIMS: Among children hospitalized for pneumonia, those with parapneumonic effusion (PPE) are at particular risk for nutritional deterioration. This study aimed to 1) investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2) determine clinical risk factors for weight loss during hospitalization; 3) describe the nutritional interventions for these children. METHODS: Retrospective chart review (January '07 - September '12) of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t0) and discharge (t1), and two weeks (t2) and one month (t3) after discharge...
2014: PloS One
Emily N Israel, Allison B Blackmer
Intrapleural fibrinolysis has been investigated for the treatment of pleural effusion for several decades. Fibrinolytics have the ability to break up fibrin and loculations that characterize complicated pleural effusions, facilitating drainage. Older fibrinolytics such as urokinase and streptokinase have been replaced by tissue plasminogen activator (tPA) for this indication due to product availability and a more favorable safety profile. The literature supports tPA as a treatment approach for this indication in adult patients, and the use of tPA has become a standard management approach in this population...
May 2014: Pharmacotherapy
Antonio Lucas L Rodrigues, Carlos Eduardo Lopes, Mariana Tresoldi das N Romaneli, Andrea de Melo A Fraga, Ricardo Mendes Pereira, Antonia Teresinha Tresoldi
OBJECTIVE To present a case of a patient with clinical and radiological features of reexpansion pulmonary edema, a rare and potentially fatal disease. CASE DESCRIPTION An 11-year-old boy presenting fever, clinical signs and radiological features of large pleural effusion initially treated as a parapneumonic process. Due to clinical deterioration he underwent tube thoracostomy, with evacuation of 3,000 mL of fluid; he shortly presented acute respiratory insufficiency and needed mechanical ventilation. He had an atypical evolution (extubated twice with no satisfactory response)...
September 2013: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
Michal Svarc, Vratislav Sedlak, Vladimir Koblizek, Frantisek Salajka, Jakub Novosad
SESSION TYPE: Infectious Disease Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Community acquired pneumonia is one of the leading cause of hospitalization worldwide. Parapneumonic pleural effusions are seen in approximately 35-40% of patients, and almost 10% require drainage. The number of all cases of pneumonia in the world rises as well as the rate of unusual etiological agents including opportunistic pathogens, such as Canida Albicans. Immune response is vital for surviving the pneumonia, which remains potentially fatal even in 21st century...
October 1, 2012: Chest
Kathryn Martin, Sherif Emil, Samara Zavalkoff, Andrea Lo, Michael Ganey, Robert Baird, Josee Gaudreault, Romain Mandel, Thérèse Perreault, Andréane Pharand
BACKGROUND: Tube thoracostomies in children are required for multiple indications and can be associated with significant discomfort. In 2010, a multidisciplinary team at our institution developed a protocol to replace stiff chest tubes with 8.5-French soft pleural catheters in children requiring pleural drainage. METHODS: Before initiating the protocol, an audit sheet was developed to prospectively capture data regarding insertion, removal, complications, and success...
October 2013: European Journal of Pediatric Surgery
Saleem Islam, Casey M Calkins, Adam B Goldin, Catherine Chen, Cynthia D Downard, Eunice Y Huang, Laura Cassidy, Jacqueline Saito, Martin L Blakely, Shawn J Rangel, Marjorie J Arca, Fizan Abdullah, Shawn D St Peter
The aim of this study is to review the current evidence on the diagnosis and management of empyema. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee compiled 8 questions to address. A comprehensive review was performed on each topic. Topics included the distinction between parapneumonic effusion and empyema, the optimal imaging modality in evaluating pleural space disease, when and how pleural fluid should be managed, the first treatment option and optimal timing in the management of empyema, the optimal chemical debridement agent for empyema, therapeutic options if chemical debridement fails, therapy for parenchymal abscess or necrotizing pneumonia and duration of antibiotic therapy after an intervention...
November 2012: Journal of Pediatric Surgery
Alaeldin H Ahmed, Tariq E Yacoub
Empyema thoracis causes high mortality, and its incidence is increasing in both children and adults. Parapneumonic effusions (PPEs) develop in about one-half of patients hospitalized with pneumonia, and their presence increases mortality by about four-fold. PPEs can be divided into simple PPEs, complicated PPEs, and frank empyema. Two guideline statements on the management of PPEs in adults have been published by the British Thoracic Society (BTS) and the American College of Chest Physicians; a third guideline statement published by the BTS focused on management of PPEs in children...
2010: Clinical Pharmacology: Advances and Applications
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