American Journal of Pediatrics

| Peer-Reviewed |

Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines

Received: May 20, 2020    Accepted: Jun. 04, 2020    Published: Jun. 16, 2020
Views:       Downloads:

Share This Article

Abstract

What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conservative management remains the mainstay for the management of parapneumonic effusion, and continuous pleural fluid drainage is not necessary in some children. However, an established consensus worldwide for the management of complicated pneumonia and thoracic empyema with different therapeutic algorithms lacks clear evidence to evaluate complex cases with minimally invasive intervention versus open decortication. Such controversy concerning the best surgical approach persists, especially for sick patients in intensive care who are not doing well despite chest tube or fibrinolytic agents. This article aimed to review current treatment standards for children with different phases of thoracic empyema and complicated pneumonia, this review article will discuss the usefulness of different diagnostic methods and most recent updates on management. 1. Outline the definition, pathophysiology and common causes 2. Review the diagnosis and current treatment standards for complicated pneumonia 3. Review different surgical approaches and their outcomes 4. Provide an update on the recent utilization of video-assisted thoracoscopy (VATS) 5. Review evidence regarding the best fibrinolytic agent 6. Review evidence concerning when to indicate decortication 7. Provide a simplified pathway for the management of complicated pneumonia (figure 9).

DOI 10.11648/j.ajp.20200603.22
Published in American Journal of Pediatrics ( Volume 6, Issue 3, September 2020 )
Page(s) 240-252
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pneumonia, Bronchopneumonia, Complicated Pneumonia, Empyema

References
[1] Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011; 128: 305-10.
[2] Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013; 61: 1-117.
[3] Helena Tresinha, Mocelin and Gilberto Bueno Fischer, epidemiology, presentation and treatment of pleural effusion. Paerdiatric respiratory review. 2002; (3), 292-297.
[4] Rees JH, Spencer DA, Parikh D, et al. Increase in incidence of childhood empyema in West Midlands, UK. Lancet 1997; 349: 402.
[5] Carrie L. Byington, LaShonda Y. Spencer, Timothy A. Johnson, Andrew T. Pavia, Daniel Allen, Edward O. Mason, Sheldon Kaplan, Karen C. Carroll, Judy A. Daly, John C. Christenson, And Matthew H. Samore. An Epidemiological Investigation of a Sustained High Rate of Pediatric Parapneumonic Empyema: Risk Factors and Microbiological Associations. Clinical Infectious Diseases 2002; 34: 434–40.
[6] Heffner JE, McDonald J, Baebieri C et al, Management of parapenumonic effusion. An analysis of physician practice patterns. Arch Surg 1995, 130: 433-438.
[7] Danasekaran R, Mani G, and Annadurai K. Prevention of healthcare-associated infections: protecting patients, saving lives. Int J Community Med Public Health. 2014; 1 (1): 67–68.
[8] Hernandez-Bou, S.; Garcia-Garcia, J. J.; Esteva, C.; Gene, A.; Luaces, C.; Munoz Almagro, C. Pediatric parapneumonic pleural effusion: Epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr. Pulmonol. 2009, 44, 1192–1200.
[9] Playford SD, Smyth AR, Stewart RJ. Increase in incidence of childhood empyema. Thorax 1997; 52: 932.
[10] Krenke, K., Urbankowska, E., Urbankowski, T., Lange, J., & Kulus, M. Clinical characteristics of 323 children with parapneumonic pleural effusion and pleural empyema due to community acquired pneumonia. Journal of Infection and Chemotherapy. 2016; 22 (5), 292–297.
[11] Harris, M.; Clark, J.; Coote, N.; Fletcher, P.; Harnden, A.; McKean, M.; Thomson, A.; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: Update 2011. Thorax 2011, 66, 1–2.
[12] Light RW, Girard WM, Jenkinson SG, et al. Parapneumonic effusions. Am J Med 1980; 69: 507-12.
[13] Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006; 3: 75-80.
[14] Li, S. T.; Tancredi, D. J. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics 2010, 125, 26–33.
[15] Yu, D.; Buchvald, F.; Brandt, B.; Nielsen, K. G. Seventeen-year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage. Acta Paediatr. 2014, 103, 93–99.
[16] British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in childhood. Thorax 2002; 57 (I): 1–24.
[17] Mukherjee. S, Langrouge B., Rosenthal M and Balfourlynn I. M. Incidence and outcome of scoliosis in children with pleural effusion Pediatr Pulmonol. 2007; 42: 221–224.
[18] Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM, Pai M. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med. 2007 Mar; 101 (3): 431-8.
[19] Miserocchi G. Physiology and pathophysiology of pleural turnover. Eur Respir J. 1997; 10: 219–2.
[20] Davies CH, Gleeson FV, Davies RJO. BTS guidelines on the management of pleural infection. Thorax 2003; 58 (II): 18–28.
[21] Quadri A, Thomson AH. Pleural fluids associated with chest infection. Paediatr Respir Rev 2002; 3: 349–55. 5.
[22] Kroegel C, Anthony VB. Immunobiology of pleural inflammation: potential implications for path genesis, diagnosis and therapy. Eur Respir J. 1997; 10: 2411–8.
[23] Adam jedaffi, and Ian M. Balfour-Lynn. Management of empyema Pediatric Pulmonology 2005; 40: 148–156.
[24] Patrick M. Meyer Sauteur, Ariane Burkhard, Ueli Moehrlen, Christa Relly, Christian Kellenberger, Kerstin Ruoss and Christoph Berge. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J. Clin. Med. 2019; 8, 698.
[25] Nyambat B, Kilgore PE, Yong DE, et al. Survey in childhood empyema in Asia: implications for detecting the unmeasured burden of culture negative bacterial disease. BMC Infect Dis. 2008; 8: 90.
[26] Spencer DA, Iqbal SM, Hasan A, Hamilton L. Empyema thoracic is still increasing in UK Children. BMJ. 2006; 332 (7553): 1333.
[27] Blaschke AJ, Heyrend C, Byington CL, et al. Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema. Pediatr Infect Dis J. 2011; 30: 289-294.
[28] Liese, J. G., Schoen, C., van der Linden, M., Lehmann, et al. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010-2017: a nationwide surveillance study. Clin Microbiol Infect. 2019; 25 (7): 857-64.
[29] Jessica Kurian, Terry L. Levin1, Bokyung K. Han, Benjamin H. Taragin and Samuel Weinstein Comparison of Ultrasound and CT in the Evaluation of Pneumonia Complicated by Parapneumonic Effusion in Children, American Journal of Roentgenology, American Journal of Roentgenology. 2009; 193: 1648-1654.
[30] Picazo J, Ruiz-Contreras J, Casado-Flores J, et al; HERACLES Study Group. Expansion of serotype coverage in the universal pediatric vaccination calendar: short term effects on age- and serotype-dependent incidence of invasive pneumococcal clinical presentations in Madrid, Spain. Clin Vaccine Immunol. 2013; 20: 1524-1530.
[31] Martin Reichert & Matthias Hecker & Biruta Witte & Johannes Bodner& Winfried Padberg & Markus AWeigand5 & Andreas Hecker1 stage-directed therapy of pleural empyema. Langenbecks Arch Surg. 2017; 402 (1): 15-26.
[32] Yu-Chao Lin, Hung-Jen Chen, Yi-Heng Liu, Chuen-Ming, Shih Wu-Huei Hsu, Chih-Yen Tu. A 30-Month Experience of Thoracic Empyema in a Tertiary Hospital: Emphasis on Differing Bacteriology and Outcome between the Medical Intensive Care Unit (MICU) and Medical Ward. South Med J. 2008 May; 101 (5): 484-9.
[33] Patra, P. K. Unusual complication of Mycoplasma pneumonia in a five-year-old child. Australasian Medical Journal. 2013; 6 (2): 73–74.
[34] Kowthar S. Hassan and Ghalib Al-Khadouri. Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion despite Treatment with Appropriate Antimicrobials. Sultan Qaboos Univ Med J. 2018; May18 (2): e239-242.
[35] Nestor, J., Huggins, T., Kummerfeldt, C., DiVietro, M., Walters, K., & Sahn, S. Viral diseases affecting the pleura. Journal of Clinical Virology. 2013; 58 (2): 367–373.
[36] R. E. Strachan, T. Gulliver, A. Martin, T. McDonald, G. Nixon, R. Roseby, S. Ranganathan, H. Selvadurai, G. Smith, S. Suresh, L. Teoh, J. Twiss, C. Wainwright, A. Jaffe. Paediatric Empyema Thoracis: Recommendations for Management. Position statement from the Thoracic Society of Australia and New Zealand. https://www.thoracic.org.au/journalpublishing/command/download_file/id/24/filename/PaediatricEmpyemaThoracisPositionStatementTSANZFINAL. pdf.
[37] Falaschi F, et al., [Comparison of computerized tomography and magnetic resonance in the assessment of benign and malignant pleural diseases]. Radiol Med, 1996. 92 (6): p. 713-8. 42. Blackmore CC, et al., Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol, 1996. 3 (2): 103-9.
[38] Hallifax, R. J., Talwar, A., Wrightson, J. M., Edey, A., & Gleeson, F. V. State-of-the-art: Radiological investigation of pleural disease. Respiratory Medicine. 2017; 124: 88–99.
[39] King S, Thomson A. Radiological perspectives in empyema. Br Med Bull 2002; 61: 203–14.
[40] Mukherjee S., Gleeson FV. Radiology in pleural disease: state of the art. Respirology. 2004; 9: 300–12.
[41] Tan Kendrick AP, Ling H, Subramanian R, Joseph VT. The value of early CT in complicated childhood pneumonia. Pediatr Radiol.. 2002; 32 (1): 16-2.
[42] Donnelly LF, Klosterman LA. CT appearance of parapneumonic effusions in children: findings are not specific for empyema. Am J Roentgenol. 1997; 169: 179–82.
[43] Kearney SE, Davies CW, Davies RJ, Gleeson FV. Computed tomography and ultrasound in parapneumonic effusions and empyema. Clin Radiol. 2000; 55 (7): 542–7.
[44] Jaffe A., Calder A D, Owens C M, Stanojevic, S Sonnappa Role of routine computed tomography in paediatric pleural empyema. Thorax 2008; 63: 897–902.
[45] Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med. 2007; 357: 2277–84.
[46] Yonggeng Goh and Jeevesh Kapur. Sonography of the pediatric chest. American Institute of Ultrasound in Medicine, J Ultrasound Med. 2016; 35: 1067–1080.
[47] Merriam MA, Cronan JJ, Dorfman GS, et al. Radiographically guided percutaneous catheter drainage of pleural collections. Am J Roentgenol. 1988; 151: 1113–6.
[48] Yang PC, Luh KT, Chang DB, et al. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. Am J Roentgenol. 1992; 159: 29–33.
[49] Lomas DJ, Padley SG, Flower CD. The sonographic appearances of pleural fluid. Br J Radiol 1993; 66: 619–24.
[50] Eibenberger KL, Dock WI, Ammann ME, et al. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994; 191: 681–4.
[51] Stavas J, van Sonnenberg E, Casola G, et al. Percutaneous drainage of infected and non-infected thoracic fluid collections. J Thoracic Imaging. 1987; 2: 80–7.
[52] Chen CH, Chen W, Chen HJ, Yu YH, Lin YC, Tu CY, Hsu WH. Transthoracic ultrasonography in predicting the outcome of small-bore catheter drainage in empyemas or complicated parapneumonic effusions. Ultrasound Med Biol. 2009; 35 (9): 1468–1474.
[53] Lange J, Krolicki L, Chiemelewska-Swewczyk D, Peradzynska J. Role of pulmonary scintigraphy in children post parapneumonic effusion and empyema. Eur Resp J. 2009; 18 (33), 170.
[54] Mew RC, Jaffe A, Biassoni L, Sonnappa S. Ventilation-perfusion scans in children treated for empyema. Thorax 2009; 64 (3): 273.
[55] IM Balfour – Lynn et al; BTS guideline for the management of pleural effusion in children. Thorax 2002; 57; 343-347.
[56] Takaoka Kazuo, Inoue Shoichi and Ohira Seiji Central Bronchopleural Fistulas Closed by Bronchoscopic Injection of Absolute Ethanol. Chest. 2002; 122 (1): 374-8.
[57] Nohynek H, Valkeila E, Leinonen M, et al. Erythrocyte sedimentation rate, white blood cell count and serum C- reactive protein in assessing etiologic diagnosis of acute lower respiratory infections in children. Pediatr Infect Dis J 1995; 14: 484–90.
[58] Korppi M, Heiskanen-Kosma T, Leinonen M. White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J 1997; 10: 1125–9.
[59] Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011; 9: 107.
[60] Korppi M, Remes S. Serum procalcitonin in pneumococcal pneumonia in children. Eur Respir J. 2001; 17: 623–7.
[61] Toikka P, Irjala K, Juven T, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000; 19: 598–602.
[62] Virkki R, Juven T, Rikalainen H, et al. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002; 57: 438–41.
[63] Alvarez-Lerma F, Marín-Corral J, Vila C, Masclans JR, González de Molina FJ, Martín Loeches I, Barbadillo S, Rodríguez A; H1N1 GETGAG/SEMICYUC Study Group. Delay in diagnosis of influenza A (H1N1) pdm09 virus infection in critically ill patients and impact on clinical outcome. Crit Care. 2016; 20 (1): 337.
[64] Atamna A, Babitch T, Bracha M, Sorek N, Haim BZ, Elis A, Bishara J, Avni T. Statins and outcomes of hospitalized patients with laboratory-confirmed 2017-2018 influenza. Eur J Clin Microbiol Infect Dis. 2019; 38 (12): 2341-8.
[65] Hardie W, Bokulic R, Garcia VF, et al. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996; 22: 1057–63.
[66] Ori et al. Pleural Effusion in Pediatric Population. Pediatrics in Review. 2002; 23 (12): 417-426.
[67] Light RW. a new classification of parapneumonic effusions and empyema. Chest 1995; 108 (2): 299–301.
[68] Andrews NC, Parker EF, Shaw RR, Wilson NJ, Webb WR (1962) Management of non tuberculous empyema: a statement of the subcommittee on surgery. Am Rev Respir Dis. 1962; 85: 935.
[69] Muers MF. Streptokinase for empyema. Lancet 1997; 349 (9064): 1491–2.
[70] Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD (2000) Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest. 118 (4): 1158–71.
[71] Hamm H, Light RW. Parapneumonic effusion andempyema. Eur Respir J 1997; 10: 1150.
[72] Lindsay McCauley, Nathan Dean. Pneumonia and empyema: causal, casual or unknown J Thorac Dis 2015; 7 (6): 992-998.
[73] Kartik Chandra Mandal, Gobinda Mandal, Pankaj Halder, Dipanwita Mitra, Bidyut Debnath, and Mala Bhattacharya. Empyema Thoracis in Children: A 5-Year Experience in a Tertiary Care Institute. J Indian Assoc Pediatr Surg. 2019 Jul-Sep; 24 (3): 197–202.
[74] Chibuk TK, Cohen E, Robinson JL, Mahant S, Hartfield DS; Paediatric complicated pneumonia: Diagnosis and management of empyema Paediatr Child Health. 2011; 16 (7): 425-7.
[75] Edward carter, John Waldhausen, Weiya Zhang, Lucas Hoffman and Gregory Peddling. Management of children with empyema: pleural drainage is not always necessary. Pediatr Pulmonol. 2010; 45 (2) 475-80.
[76] Baumer H. J. “guidelines review – parapneumonic effusion and empyema, Arch Dis of childhood: 2005: 90: 21–24.
[77] Janahi IA, Fakhoury K. Management and prognosis of parapneumonic effusion and empyema in children. Up-to-date. 2012. http://www.uptodate.com/contents/management-and-prognosis-of-parapneumonic-effusionand-empyema-in-children. Accessed March 14, 2014.
[78] Shoseyov, D., Bibi, H., Shatzberg, G., Klar, A., Akerman, J., Hurvitz, H., & Maayan, C. Short-term Course and Outcome of Treatments of Pleural Empyema in Pediatric Patients. Chest. 2002; 121 (3), 836–840.
[79] Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg. 2007; 133 (2): 346–351.
[80] Loizzi, M., De Palma, A., Pagliarulo, V., Loizzi, D., & Sollitto, F. Pulmonary Infections of Surgical Interest in Childhood. Thoracic Surgery Clinics. 2012; 22 (3), 387–401.
[81] Segerer FJ, Seeger K, Maier A, Hagemann C, et al. Therapy of 645 children with parapneumonic effusion and empyema a German nationwide surveillance study. Pediatr Pulmonol. 2017; 52 (4): 540-7.
[82] Bradley JS, Byington CL, Shah SS, et al, and the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011; 53 (7): 25-76.
[83] Balfour-Lynn IM, Abrahamson E, Cohen G, et al; Paediatric Pleural Diseases Subcommittee of the BTS Standards of Care Committee. BTS guidelines for the management of pleural infection in children. Thorax. 2005; 60 (1): 11-21.
[84] Joyce A. Generali, and Dennis J. Cada, Alteplase: Pleural Effusion (Parapneumonic) and Empyema in chie Hosp Pharm 2013; 48 (11): 912–918.
[85] Yao CT, Wu JM, Liu CC, Wu MH, Chuang HY, Wang JN. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest. 2004; 125: 566–571.
[86] Aydoğan, M., Aydoğan, A., Özcan, A., Tugay, M., Gokalp, A. S., & Arısoy, E. S. Intrapleural streptokinase treatment in children with empyema. European Journal of Pediatrics. 2007; 167 (7), 739–744.
[87] Cohen E, et al, Cost-effectiveness of competing strategies for the treatment of pediatric empyema. Pediatrics. 2008; 121: 1250–7.
[88] Ekta Singh, Anuj Kumar, D. Y. Shrikhande, P. Nigwekar. Role of Intrapleural Streptokinase in Children with Empyema - Randomised Controlled Trial. International Journal of Contemporary Medical Research. 2017, 4 (11): 2221-4.
[89] Joseph L. Mathew, Vemlish Soni et al. Intrapleural streptokinase is effective and safe for children with multi Loculated empyema regardless of the time from disease onset. Acta Paediatr. 2018; 107 (12): 2165-71.
[90] Mathew, J. L. (2019). Intrapleural Fibrinolytic Therapy in Empyema Thoracic: Where are we now and where do we go from here? The Indian J Pediatr. 2019; 86 (12): 1081-2.
[91] Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM. Randomized trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002; 57 (4): 343–347.
[92] Marhuenda C., Barcelo, C., Fuentes, I., Guillen, G., Cano, I., Lopez, M., Moreno-Galdo, A. (2014). Urokinase versus VATS for Treatment of Empyema: A Randomized Multicenter Clinical Trial. PEDIATRICS, 134 (5), 1301–07.
[93] Stefanutti, G., Ghirardo, V., Barbato, A., & Gamba, P. Evaluation of a pediatric protocol of intrapleural urokinase for pleural empyema: A prospective study. Surgery. 2010; 148 (3): 589–594.
[94] Thomson A H, J Hull, M R Kumar, C Wallis, I M Balfour Lynn Randomized trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 2002; 57 343-347.
[95] Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology. 2003; 228 (2): 370-378.
[96] Ray TL, Berkenbosch JW, Russo P, Tobias JD. Tissue plasminogen activator as an adjuvant therapy for pleural empyema in pediatric patients. J Intens Care Med. 2004; 19 (1): 44-50.
[97] Hendaus MA, Abushahin A. Intrapleural hemorrhage due to alteplase use in a 6-year-old boy with pleural effusion. Int J Gen Med. 2013; 6: 233-236.
[98] Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: A prospective, randomized trial. J Pediatr Surg. 2009; 44 (1): 106-111.
[99] Weinstein M, Restrepo R, Chait PG, Connolly B, Temple M, Macarthur C. Effectiveness and safety of tissue plasminogen activator in the management of complicated parapneumonic effusions Pediatrics. 2004; 113 (3): 182-5.
[100] Michael H, Livingston, Sanjay Mahant, Felix Ratjen, et al. Intrapleural Dornase and TissuePlasminogen Activator in pediatric empyema (DTPA): a study protocol for arandomized controlled trial. Trials 2017; 18: 293.
[101] Najib M. Rahman, Nicholas A. Maskell, Alex West, Richard Teoh, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365 (6): 518-26.
[102] Adel Salah Bediwy and Hesham Galal Amer. Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies. International Scholarly Research Network. 2012; Article ID 143295, 6 pages.
[103] Chien-Heng Lin, Wei-Ching Lin, Jeng-Sheng Chang: Comparison of Pigtail Catheter with Chest Tube for Drainage of Parapneumonic Effusion in Children. Pediatrics and Neonatology. 2011); 52: 337-41.
[104] Redden, M. D., Chin, T. Y., & van Driel, M. L. (2017). Surgical versus non-surgical management for pleural empyema. Cochrane Database of Systematic Reviews.
[105] Kamal Kumar, Sujatha Basker, [...], and Archana Matthias. Anaesthesia for Pediatric Video Assisted Thoracoscopic Surgery. J Anaesthesiol Clin Pharmacol. 2011; 27 (1): 12–16.
[106] Landerenear R J, Hazelrigg SR, Mack HJ, et al. Post-operative pain -related morbidity: Video- assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993; 56: 1285–9.
[107] Mocelin et al. “epidemiology, presentation and Rx of PE” Ped. Resp. Review 2002; 3 (4): 292-297.
[108] Waseem M, Hajjar, Iftikhar Ahmed, Sami A Al-Nassar, Rawan k Alsultan, Waad A Alwgait, Hanoof H. Alkhalf, Shekhar C. Bisht, Video-assisted thoracopsic decortication for the management of late stage pleural empyema, is it feasible? Ann thorac med. 2016; 11 (1): 71–78.
[109] Knebel, R., Fraga, J. C., Amantea, S. L., & Isolan, P. B. S. Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion. Jornal de Pediatriar 2018; 94 (2), 140–145.
[110] Shah SS, Di Cristina CM, Bell LM, Ten Have TR, Metlay JP. Primary early thoracoscopy andReduction in length of hospital stay and additional procedures among children with complicated Pneumonia: results of a multi-center retrospective cohort study. Arch Pediatr Adolesc Med. 2008; 162 (7): 675–81.
[111] Kurt BA, Winter halter KM, Connors RH, Betz BW, and Winters JW. Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 2006; 118 (3): 547–53.
[112] Swanson SJ, Herndon 2nd JE, D’ Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ. Video-assisted thoracic Surgery lobectomy: report of CALGB 39802–a prospective, multi institution feasibility study. J Clin Oncol 2007; 25 (31): 4993–7.
[113] Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009; 27 (15): 2553–2562.
[114] Demmy TL, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg. 2008; 85 (2): 719–28.
[115] Gockce M, Okur E, Baysungur V, et al. Lung decortication for chronic empyema: effect on pulmonary function and thoracic asymmetry in later period. Eur J cardiothorac Surg. 2009; 36: 754-758.
[116] Andrade- Alegre R, Garisto JD, Zebede S. Open thoracotomy and decortication for chronic empyema. (Clinics (Sap Paulo) 2008; 63 (6): 789-793.
[117] Grotenhuis BA, Janssen PJ, Erenberg JP. The surgical treatment for stage III Empyema: the effect on the lungs. Minerva Chir 2008; 63 (1): 23-27.
[118] Menon, P., Kanojia, R., & Rao, K. L. Empyema thoracis: Surgical management in children. Journal of Indian Association of Pediatric Surgeons 2009; 14 (3), 85-93.
Cite This Article
  • APA Style

    Abdullah Saeed Al-Shamrani. (2020). Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines. American Journal of Pediatrics, 6(3), 240-252. https://doi.org/10.11648/j.ajp.20200603.22

    Copy | Download

    ACS Style

    Abdullah Saeed Al-Shamrani. Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines. Am. J. Pediatr. 2020, 6(3), 240-252. doi: 10.11648/j.ajp.20200603.22

    Copy | Download

    AMA Style

    Abdullah Saeed Al-Shamrani. Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines. Am J Pediatr. 2020;6(3):240-252. doi: 10.11648/j.ajp.20200603.22

    Copy | Download

  • @article{10.11648/j.ajp.20200603.22,
      author = {Abdullah Saeed Al-Shamrani},
      title = {Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines},
      journal = {American Journal of Pediatrics},
      volume = {6},
      number = {3},
      pages = {240-252},
      doi = {10.11648/j.ajp.20200603.22},
      url = {https://doi.org/10.11648/j.ajp.20200603.22},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20200603.22},
      abstract = {What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conservative management remains the mainstay for the management of parapneumonic effusion, and continuous pleural fluid drainage is not necessary in some children. However, an established consensus worldwide for the management of complicated pneumonia and thoracic empyema with different therapeutic algorithms lacks clear evidence to evaluate complex cases with minimally invasive intervention versus open decortication. Such controversy concerning the best surgical approach persists, especially for sick patients in intensive care who are not doing well despite chest tube or fibrinolytic agents. This article aimed to review current treatment standards for children with different phases of thoracic empyema and complicated pneumonia, this review article will discuss the usefulness of different diagnostic methods and most recent updates on management. 1. Outline the definition, pathophysiology and common causes 2. Review the diagnosis and current treatment standards for complicated pneumonia 3. Review different surgical approaches and their outcomes 4. Provide an update on the recent utilization of video-assisted thoracoscopy (VATS) 5. Review evidence regarding the best fibrinolytic agent 6. Review evidence concerning when to indicate decortication 7. Provide a simplified pathway for the management of complicated pneumonia (figure 9).},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines
    AU  - Abdullah Saeed Al-Shamrani
    Y1  - 2020/06/16
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajp.20200603.22
    DO  - 10.11648/j.ajp.20200603.22
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 240
    EP  - 252
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20200603.22
    AB  - What is already known? Complicated pneumonia is an area of debate, and a rapid diagnosis is essential for patient survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems have been established. Depending on the stage of the disease, both antimicrobial and interventional approaches are indicated. Conservative management remains the mainstay for the management of parapneumonic effusion, and continuous pleural fluid drainage is not necessary in some children. However, an established consensus worldwide for the management of complicated pneumonia and thoracic empyema with different therapeutic algorithms lacks clear evidence to evaluate complex cases with minimally invasive intervention versus open decortication. Such controversy concerning the best surgical approach persists, especially for sick patients in intensive care who are not doing well despite chest tube or fibrinolytic agents. This article aimed to review current treatment standards for children with different phases of thoracic empyema and complicated pneumonia, this review article will discuss the usefulness of different diagnostic methods and most recent updates on management. 1. Outline the definition, pathophysiology and common causes 2. Review the diagnosis and current treatment standards for complicated pneumonia 3. Review different surgical approaches and their outcomes 4. Provide an update on the recent utilization of video-assisted thoracoscopy (VATS) 5. Review evidence regarding the best fibrinolytic agent 6. Review evidence concerning when to indicate decortication 7. Provide a simplified pathway for the management of complicated pneumonia (figure 9).
    VL  - 6
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Pediatrics, Prince Sultan Military Medical City (PSMMC), Alfaisal University, Riyadh, Saudi Arabia

  • Section