Zuhdi M K, Spear R M, Worthen H M, Peterson B M
Department of Pediatric Critical Care, Children's Hospital of San Diego, CA 92123, USA.
Crit Care Med. 1996 Feb;24(2):330-3. doi: 10.1097/00003246-199602000-00024.
To describe the use of percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children.
Retrospective case series.
A 24-bed pediatric intensive care unit.
Patients with tension pneumatocele, secondarily infected pneumatocele, or lung abscess. Tension pneumatocele was defined as an expanding intraparenchymal cyst compressing adjacent areas of the lung. Infected pneumatocele and lung abscess were defined, respectively, as intraparenchymal thin-walled cyst or thick-walled cavity containing an air-fluid level and purulent fluid.
Seven pneumatoceles/lung abscesses were percutaneously drained in five patients. After computed tomography of the chest was obtained to localize the optimum site for drainage, a modified Seldinger technique was used to insert an 8.5-Fr soft catheter percutaneously into the cyst/cavity. The catheter was left in place until drainage (fluid and air) stopped.
All patients had clinical and radiologic improvement and were afebrile within 24 hrs after drainage. Bacterial culture grew aerobic bacteria from three cysts/cavities, anaerobic bacteria from one, and mixed bacteria from three. One patient had three secondarily infected pneumatoceles. Four of five secondarily infected pneumatoceles were under tension in two patients receiving mechanical ventilation. In both patients, the trachea was extubated within 24 hrs of drainage after prolonged mechanical ventilation. The number of days the catheter was in place ranged from 1 to 20 days.
Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess can be performed safely and effectively in children. Early drainage is helpful, both as a diagnostic and therapeutic procedure. Drainage of tension pneumatocele may assist in weaning from mechanical ventilation. Computed tomography of the chest is helpful in determining the optimum site for percutaneous drainage.
描述经皮导管引流术在儿童张力性肺气囊、继发感染性肺气囊及肺脓肿中的应用。
回顾性病例系列研究。
一家拥有24张床位的儿科重症监护病房。
患有张力性肺气囊、继发感染性肺气囊或肺脓肿的患者。张力性肺气囊定义为扩张的肺实质内囊肿压迫相邻肺组织区域。感染性肺气囊和肺脓肿分别定义为肺实质内薄壁囊肿或厚壁空洞，内含气液平面和脓性液体。
5例患者的7个肺气囊/肺脓肿接受了经皮引流。在进行胸部计算机断层扫描以确定最佳引流部位后，采用改良Seldinger技术经皮将一根8.5F的软导管插入囊肿/空洞。导管留置至引流（液体和气体）停止。
所有患者在引流后24小时内临床和影像学均有改善且体温正常。细菌培养显示，3个囊肿/空洞培养出需氧菌，1个培养出厌氧菌，3个培养出混合菌。1例患者有3个继发感染的肺气囊。在接受机械通气的2例患者中，5个继发感染的肺气囊中有4个处于张力状态。在这2例患者中，经过长时间机械通气后，均在引流后24小时内拔除气管插管。导管留置天数为1至20天。
经皮导管引流术可安全有效地应用于儿童张力性肺气囊、继发感染性肺气囊及肺脓肿。早期引流作为一种诊断和治疗手段很有帮助。张力性肺气囊的引流可能有助于撤机。胸部计算机断层扫描有助于确定经皮引流的最佳部位。
