Management of empyema in children

Article Abstract:

The causes, incidence, and seriousness of empyema (accumulation of pus in a body cavity, particularly in the pleural space, as a result of bacterial infection) have been greatly changed by the use of antibiotics. The organisms causing empyema in children have also changed. Improvement has been obtained in the control of empyema that results as a complication of pneumonia, however, the relative incidence of other causes has increased. The current goals of treatment for empyema are to decrease illness and shorten the hospital stay. Treatment includes drainage of the chest cavity, with or without more aggressive surgery. A review of the treatment of empyema is presented to define the rationale for using early decortication (removal of the outer layer of the pleura, the membrane covering the lung) in selected patients. A group of 27 children with empyema were treated over an 11-year period; the children ranged in age from newborn to 12 years. Ten cases developed following esophageal or abdominal surgery. The children had symptoms including fever, cough, tube drainage following surgery, lack of appetite, weight loss, chest pain and difficulty breathing. Treatment included thoracentesis (removal of fluid from the chest cavity), antibiotics, and placement of chest tubes. Decortication was performed on 10 patients, with two deaths. The average hospital stay for the group was 28.3 days; for patients treated by decortication it was 11.6 days. Children should be treated with antibiotics while awaiting identification of the causative organism. A child with persistent pleural infection can greatly benefit from decortication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Demographic aspects, Surgery

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The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage

Article Abstract:

Prehospital and emergency room recordings of vital signs pertaining to the flow of blood frequently play a major role in evaluating and treating injury victims. Guidelines for resuscitation and treatment are expressed in terms of absolute cutoff values for certain vital signs. The sensitivity of systolic (when the heart is contracting, pumping blood to the body) blood pressure and heart rate for identifying patients suffering from major blood loss in the chest and abdomen was studied. A third of all patients reaching the emergency room did so with normal blood pressure, and more than three-quarters of patients reaching the emergency room attained normal blood pressure while being evaluated there. Sensitivity of various vital signs for identification increased as the variance from normal grew. Standard cutoff guidelines were relatively insensitive for identifying this group. Normal vital signs after injury do not prove the absence of life-threatening blood loss, and abnormal vital signs at any point after injury require investigation to rule out significant blood loss (hemorrhage).

Analysis, Diagnosis, Measurement, Practice, Hemorrhage, Blood pressure, Abdomen, Hemodynamic monitoring, Blood pressure measurement, Emergency medicine, Pulse, Abdominal injuries

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Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma

Article Abstract:

The vast majority of victims of thoracic (region of the chest containing the lungs) injury require only observation or the insertion of a tube into the thorax to drain fluid. Although such tube insertion is generally considered to be a relatively minor procedure, between 2 and 25 percent of patients who undergo this procedure develop infection. The incidence of and risk factors for the accumulation of pus (empyema) in the thorax after thoracostomy was studied. The risk of pus accumulation was higher in patients in whom the areas surrounding the lungs had been incompletely drained of fluid and in whom the chest tubes were in place for a long period of time.

Infection, Complications and side effects, Wounds and injuries, Chest, Chest Surgery, Thoracic injuries

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