Moral Luis, Toral Teresa, Clavijo Agustín, Caballero María, Canals Francisco, Forniés María José, Moral Jorge, Revert Raquel, Lucas Raquel, Huertas Ana María, González María Cristina, García-Avilés Belén, Belda Mónica, Marco Nuria
Pediatric Respiratory and Allergy Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
Department of Pediatrics, Marina Baixa Hospital, Villajoyosa, Spain.
Front Pediatr. 2021 Jul 21;9:621943. doi: 10.3389/fped.2021.621943. eCollection 2021.
The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD). Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018. A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) ( < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 ( < 0.001). The referral of patients with PE+1 decreased over time ( = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group ( = 0.018), without affecting LHS ( = 0.814). There were no changes in the use of CTPD in the PE+3 group ( = 0.721). The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.
包括脓胸在内的类肺炎性胸腔积液（PPE）的最佳治疗方法存在争议。我们分析了本中心及其参考区域内医院在采用更保守的方法减少胸管胸腔引流（CTPD）使用后的经验。回顾了2010年至2018年九家医院所有PPE患者的临床记录。共审查了318例PPE病例；其中157例积液厚度<10mm。其余161例厚度为10mm或更厚，并细分为三个逐渐增大的尺寸：PE+1、PE+2和PE+3。积液大小与复杂性积液/脓胸之间存在密切关系，复杂性积液/脓胸由影像学检查表现或胸腔积液的物理或细菌学特征定义。积液大小也与发热持续时间和静脉治疗密切相关，是住院时间（LHS）的最佳独立预测因素（<0.001）。CTPD在2.9%的PE+1患者、19.3%的PE+2患者和63.9%的PE+3患者中使用（<0.001）。随着时间的推移，PE+1患者的转诊率下降（=0.033），PE+1/PE+2联合组中CTPD的使用也下降（=0.018），但不影响住院时间（=0.814）。PE+3组中CTPD的使用没有变化（=0.721）。PPE的大小与其严重程度和住院时间密切相关。大多数患者仅用抗生素治疗即可。
