RESUMEN
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.
RESUMO Objetivo: Avaliar o melhor momento para a realização de toracoscopia no tratamento de derrame pleural parapneumônico complicado na fase fibrinopurulenta em pacientes ≤ 14 anos de idade quanto a evolução e ocorrência de complicações pós-operatórias. Métodos: Estudo retrospectivo e comparativo com pacientes com derrame pleural parapneumônico que apresentavam septações ou loculações à ultrassonografia de tórax e que foram submetidos a toracoscopia no período entre janeiro de 2000 e janeiro de 2013. Os pacientes foram divididos em dois grupos: toracoscopia precoce (TP), realizada até o 5º dia da hospitalização; e toracoscopia tardia (TT), realizada após o 5º dia de internação. Resultados: Foram incluídas 60 pacientes, 30 em cada grupo. A média de idade foi de 3,4 anos, 28 pacientes (46,7%) eram do sexo masculino, e 47 (78,3%) foram submetidos à toracoscopia primária, sem realização de drenagem simples prévia. Os grupos TP e TT foram semelhantes quanto ao sexo, idade, peso e tipo de toracoscopia (p > 0,05 para todos). Observou-se uma diferença significativa quanto à média de duração da internação nos grupos TP e TT (14,5 dias vs. 21,7 dias; p < 0,001). Houve também diferenças significativas entre os grupos quanto ao total de dias com febre, total de dias entre internação e início da drenagem e total de dias com dreno. Oito pacientes (13,6%) apresentaram alguma complicação após a toracoscopia, sem diferença entre os grupos. Não houve óbitos. Conclusões: A TP, realizada até o 5º dia da admissão hospitalar, associou-se a menor duração da internação, menor tempo de drenagem e menor duração da febre, sem estar associada a maior frequência de complicações, necessidade de CTI ou hemotransfusão.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Derrame Pleural/cirugía , Toracoscopía/métodos , Tiempo de Internación , Derrame Pleural/diagnóstico por imagen , Estudios Retrospectivos , Factores de TiempoRESUMEN
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.
Asunto(s)
Derrame Pleural/cirugía , Toracoscopía/métodos , Preescolar , Femenino , Humanos , Tiempo de Internación , Masculino , Derrame Pleural/diagnóstico por imagen , Estudios Retrospectivos , Factores de TiempoRESUMEN
O derrame pleural parapneumônico representa um desafio para o pediatra no tratamento das pneumonias bacterianas. O objetivo do presente estudo é fazer uma revisão da literatura dos aspectos clínico-cirúrgicos na abordagem do derrame pleural em Pediatria. Trabalhos recentes têm proporcionado melhor compreensão da sua evolução e orientado a melhor abordagem, incluindo a utilização da ultrassonografia de tórax. A videotoracoscopia é um procedimento cirúrgico seguro e eficiente, devendo ser realizado por profissional capacitado em centros de referência. Os fibrinolíticos surgem como opção interessante e de bom custo-benefício em serviços sem cirurgião-pediatra. O tratamento adequado dirigido à fase evolutiva do derrame pleural tem evitado a internação prolongada e as complicações tardias, como o encarceramento pulmonar, proporcionando melhor qualidade da assistência e redução do sofrimento físico e emocional das crianças e suas famílias.
The parapneumonic pleural effusion represents a challenge to the pediatrician in the treatment of bacterial pneumonia. The aim of this study is to review the literature about the clinical-surgical aspects in the approach of the pleural effusion in Pediatrics. Recent studies have provided a better understanding of its evolution and improved approach, including the use of chest ultrasound. The video-assisted thoracic surgery is a safe and efficient procedure, and should be carried out by skilled professionals in reference centers. The fibrinolytics appear as an interesting option associated to cost-effective services without the need of a pediatric surgeon. The proper treatment for the evolutionary stage of pleural effusion has prevented prolonged hospitalizations and late complications, such as pulmonary incarceration, provided better quality of care, and reduced physical and emotional suffering in children and their families.