Management of empyema thoraces in our setup

To find out the proper method of management of empyema thoraces to be adopted according to the stage of disease. Prospective study. This study was carried out at Children Hospital Complex, Multan in department of Paediatric Surgery from January 2003 to December 2005 for a period of three years. Fifty patients of post pneumonic empyema thoraces were managed from January 2003 to December 2005. All of them were included in the study. On basis of history, examination and investigations disease was staged as I, II and III. In addition to antibiotics according to culture and sensitivity, intercostals chest tube drainage was performed in all the patients of Stage-I and II. Out of fifty patients thirty four [68%] were male and sixteen [32%] female. Thirty nine [78%] were under 5 years and eleven [22%] of 6-12 years of age. Right side was involved in thirty two [64%] and left side in eighteen [36%]. Twenty nine [58%] were suffering from Stage-I, thirteen [26%] Stage-II and eight [16%] from Stage-Ill. Intercostals chest tube drainage was performed in Stage-I and II. All of the twenty nine [100%] of Stage-I and five out of thirteen [38%] of Stage-II recovered successfully. Thoracotomy was performed in all eight patients of Stage-III straight forward and eight out of thirteen of Stage-II who did not recovered after chest tube drainage. Fifteen out of these sixteen [94%] recovered, one [6%] developed sepsis and expired on 6[th] day after thoracotomy. Tube drainage is very much successful in Stage-I. Early thoracotomy is an excellent option to treat Stage-II and III. Pus drainage facilitative measures are helpful in evacuation of the pus and expansion of lungs

Scoring system for empyema thoracis and help in management.

OBJECTIVE: To evaluate the implications of a newly defined severity scoring of empyema in children for the prediction of surgical management and to compare the length of hospitalization as an outcome measure of patients treated using medical therapy, salvage video-assisted thoracoscopic surgery (VATS) vs early elective VATS. METHODS: A retrospective chart review of parapneumonic empyema of patients below 18 years of age admitted to a tertiary children's hospital in northern Taiwan from April 1993 to December 2002 was performed. Patients were categorized into a medical group who received antibiotic therapy, needle aspirations with/without tube thoracostomy; a salvage VATS group when the patients required surgery for the relief of persistent fever > 38 degrees C, chest pains or dyspneic respirations despite initial medical therapy; an early VATS group when the patients received elective surgery early after admission. The demographic data, clinical features, laboratory findings, and duration of hospitalization were compared using a severity score of empyema (SSE). RESULTS: Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, Pseudomonas aeruginosa. No organisms were recovered in 39% of patients. A pleural pH < 7.1 increases the odds of requiring surgical intervention by 6 times among this cohort. Children who required decortication of empyema had a higher severity score (mean 4.8 vs 3.0, p < 0.005). The duration of hospitalization for patients having early VATS showed a shortening stay (mean 18 vs 28 days) as compared to salvage VATS. CONCLUSION: A pleural pH < 7.1 and a newly designed clinical severity score of empyema 4 are two predictors of surgical intervention for fibrinopurulent empyema in the present study. Early elective VATS may be adopted not later than 7 days after failure of appropriate antibiotic therapy and adequate drainage of empyema to decrease the length of stay and minimize morbidity.