Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Seydou Togo^1*, Moussa Abdoulaye Ouattara¹, Ibrahim Sangaré¹, Jacque Saye¹, Cheik Amed Sékou Touré¹, Ibrahim Boubacar Maiga¹, Dokore Jerome Dakouo¹, Liang Guo², Sékou Koumaré³, Adama Konoba Koita³, Zimogo Zié Sanogo³, Sadio Yéna¹

¹Thoracic Surgery Department, Hospital of Mali, Bamako, Mali.
²23ème Chinese Aids Medical Team, Hospital of Mali, Bamako, Mali.
³Surgery “A” Department, Hospital of Point G, Bamako, Mali.

DOI: 10.4236/ss.2015.612077                

Abstract

Drainage by chest tube thoracostomy is widely used in treatment of early empyema thoracis in children, but drainage with antiseptic lavage-irrigation is more frequent in our context since the last 20 years. This study was to determine which was more effective in our experience comparing chest tube drainage with catheter antiseptic lavage-irrigation versus drainage by chest tube thoracostomy alone in the management of empyema thoracis in children. Patients and Methods: Demographic, clinical and microbiological data on children with thoracic empyema undergoing drainage by chest tube thoracostomy alone or with antiseptic lavage-irrigation were obtained from 2 thoracic surgical centers from September 2008 to December 2014. It was a retrospective study included 246 children (137 boys and 109 girls) who were managed for empyema thoracis at the author’s different department of surgery. Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was analyzed and compared in the 2 groups. Results: Drainage of pus and antiseptic irrigation resulted in resolution of pyrexia with improvement in general condition in 85.82% of patients in group 1 and by tube thoracostomy alone in 73.95% in group 2. There are a significant difference in the length of hospital stay (p = 0.022), duration of chest tubes in situ (p = 0.040), treatment coast (p = 0.015) and outcome of stage 2 empyema disease (p = 0.037) between the 2 groups. Conclusion: it seems that chest tube drainage with antiseptic lavage-irrigation method is associated with a higher efficacy, shorter length of hospital stay, shorter duration of chest tube in situ, less cost and better outcome of stage 2 empyema diseases than a treatment strategy that utilizes chest tube thoracostomy alone.

Keywords

Empyema, Thoracis, Children, Irrigation, Drainage

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Satish, B., Bunker, M. and Seddon, P. (2003) Management of Thoracic Empyema in Childhood: Does the Pleural Thickening Matter? Archives of Disease in Childhood, 88, 918-921. http://dx.doi.org/10.1136/adc.88.10.918
[2]	Yilmaz, E., Dogan, Y., Aydinoglu, A.H., Gurgoze, M.K. and Aygun, D. (2002) Parapneumonic Empyema in Children: Conservative Approach. The Turkish Journal of Pediatrics, 44, 134-138.
[3]	Long, A.M., Smith-Williams, J., Mayell, S., Couriel, J., Jones, M.O. and Losty, P.D. (2015) “Less May Be Best”— Pediatric Parapneumonic Effusion and Empyema Management: Lessons from a UK Center. Journal of Pediatric Surgery, 12, 455-458.
[4]	Yao, C.T., Wu, J.M., Liu, C.C., Wu, M.H., Chuang, H.Y. and Wang, J.N. (2004) Treatment of Complicated Parapneumonic Pleural Effusion with Intrapleural Streptokinase in Children. Chest, 125, 566-571. http://dx.doi.org/10.1378/chest.125.2.566
[5]	Light, R.W. (1995) A New Classification of Parapneumonic Effusions and Empyema. Chest, 108, 299-301. http://dx.doi.org/10.1378/chest.108.2.299
[6]	Rzyman, W., Skokowski, J., Romanowicz, G., Lass, P. and Dziadziuszko, R. (2002) Decortications in Chronic Pleural Empyema—Effect on Lung Function. European Journal Cardio-Thoracic Surgery, 21, 502-507. http://dx.doi.org/10.1016/S1010-7940(01)01167-8
[7]	Goyal, V., Kumar, A., Gupta, M., Sandhu, H.P. and Dhir, S. (2014) Empyema Thoracis in Children: Still a Challenge in Developing Countries. African Journal of Paediatric Surgery, 11, 206-210. http://dx.doi.org/10.4103/0189-6725.137326
[8]	Misthos, P., Sepsas, E., Konstantinou, M., Athanassiadi, K., Skottis, I. and Lioulias, A. (2005) Early Use of Intrapleural Fibrinolytics in the Management of Postpneumonic Empyema. A Prospective Study. European Journal Cardio-Thoracic Surgery, 28, 599-603. http://dx.doi.org/10.1016/j.ejcts.2005.07.005
[9]	Huang, H.C., Chang, H.Y., Chen, C.W. and Lee, C.H. (1999) Predicting Factors for Outcome of Tube Thoracostomy in Complicated Parapneumonic Effusion or Empyema. Chest, 115, 751-756. http://dx.doi.org/10.1378/chest.115.3.751
[10]	Mandal, A.K., Thadepalli, H., Mandal, A.K. and Chetipally, U. (1998) Outcome of Primary Emypema Thoracis: Therapeutic and Microbiologic Aspects. The Annals of Thoracic Surgery, 66, 1782-1786. http://dx.doi.org/10.1016/S0003-4975(98)00601-8
[11]	Ris, H.B., Pezzetta, E., Krueger, T. and Lardinois, D. (2004) Surgical Treatment of Pleural Infections: The Surgeon’s Point of View. European Respiratory Monograph, 29, 181-188. http://dx.doi.org/10.1183/1025448x.00029012
[12]	Waller, D.A. and Rengarajan, A. (2001) Thoracoscopic Decortication: A Role for Video-Assisted Surgery in Chronic Postpneumonic Pleural Empyema. The Annals of Thoracic Surgery, 71, 1813-1816. http://dx.doi.org/10.1016/S0003-4975(01)02471-7
[13]	Roberts, J.R. (2003) Minimally Invasive Surgery in the Treatment of Empyema: Intraoperative Decision Making. The Annals of Thoracic Surgery, 76, 225-230. http://dx.doi.org/10.1016/S0003-4975(03)00025-0
[14]	Scarci, M., Abah, U. and Solli, P. (2015) EACTS Expert Consensus Statement for Surgical Management of Pleural Empyema. European Journal of Cardio-Thoracic Surgery, 48, 642-653. http://dx.doi.org/10.1093/ejcts/ezv272
[15]	Bose, K., Saha, S., Mridha, D., Das, K., Mondal, P. and Das, I. (2015) Analysis of Outcome of Intraplueral Streptokinase in Pediatric Empyema Thoracis Even in Advanced Stages: A Prospective Study. Iranian Journal of Pediatrics, 25, e3154. http://dx.doi.org/10.5812/ijp.3154
[16]	Jaffe, A. and Cohen, G. (2003) Thoracic Empyema. Archives of Disease in Childhood, 88, 839-841. http://dx.doi.org/10.1136/adc.88.10.839
[17]	Cohen, G., Hjortdal, V., Ricci, M., et al. (2003) Primary Thoracoscopic Treatment of Empyema in Children. Journal of Thoracic and Cardiovascular Surgery, 125, 79-83. http://dx.doi.org/10.1067/mtc.2003.88
[18]	Doski, J.J., Lou, D., Hicks, B.A., et al. (2000) Management of Parapneumonic Collections in Infants and Children. Journal of Pediatric Surgery, 35, 265-268. http://dx.doi.org/10.1016/S0022-3468(00)90022-8
[19]	Alexiou, C., Goyal, A., Firmin, R.K. and Hickey, M.S. (2003) Is Open Thoracotomy Still a Good Treatment Option for the Management of Empyema in Children? The Annals of Thoracic Surgery, 76, 1854-1858. http://dx.doi.org/10.1016/S0003-4975(03)01076-2
[20]	Hilliard, T.N., Henderson, A.J. and Langton Hewer, S.C. (2003) Management of Parapneumonic Effusion and Empyema. Archives of Disease in Childhood, 88, 915-917. http://dx.doi.org/10.1136/adc.88.10.915
[21]	Saleem, A.F., Shaikh, A.S., Khan, R.S., Khan, F., Faruque, A.V. and Khan, M.A. (2014) Empyema Thoracis in Children: Clinical Presentation, Management and Complications. Journal of the College of Physicians and Surgeons Pakistan, 24, 573-576.
[22]	Avansino, J.R., Goldman, B., Sawin, R.S. and Flum, D.R. (2005) Primary Operative versus Nonoperative Therapy for Pediatric Empyema: A Meta-Analysis. Pediatrics, 115, 1652-1659. http://dx.doi.org/10.1542/peds.2004-1405