Source: Annual Congress 2006 - Pneumonia and other invasive pulmonary infections in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

The incidence of paediatric empyema is increasing but the optimum management still remains controversial. High dose intravenous antibiotics only , drainage with large bore stiff drains (SD) or percutaneous soft drains (PD) with or without intrapleural fibrinolytics and a variety of other procedures (repeated aspiration , primary thoracotomy with decortication , and video assisted thoracic surgery ) have been advocated . Chest drains may be inserted under general anaesthesia (GA) or conscious sedation (CS). Our routine primary treatment is intercostal drainage and use of intrapleural fibrinolytics, but the variation in type of drain and anaesthesia used has provided useful observational information on outcomes, particularly with reference to the type of anaesthesia used.
We conducted a retrospective notes review of all 74 cases of paediatric empyema or symptomatic parapneumonic effusion over 6 years. The number of cases admitted increased during the second three years of the study (47 vs 27, p<0.05). 61 children had chest drains inserted.The median age was 4.9 years. The median length of stay (LOS) post procedure was 8 days (range 4-33) and was similar with PD regardless of GA or CS. Use of a SD was associated with an increased LOS (median 10 days, range 5-33), although this did not reach statistical significance.

Outcome by drain type and anaesthesia.

	SD (GA)	PD (GA)	PD (CS)
Number	15	25	21
Age (years)	5.48	5.34	4.9
Median (interquartile range) length of stay post procedure	10 (8,12)	8 (6,12)	8 (6,11)

Our findings supports the use of PD rather than SD, but we found no difference in LOS based on type of anaesthesia.An incidental benefit is that GA allows the painless insertion of a long line for secure venous access.

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Citations should be made in the following way:
J. M. Bhatt, S. Marven, M. L. Everard, J. Walker, R. A. Primhak (Nottingham, Sheffield, United Kingdom). Anaesthesia and drain type in paediatric empyema: an observational study. Eur Respir J 2006; 28: Suppl. 50, 1799

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