EARLY DECORTICATION FOR POSTPNEUMONIC EMPYEMA IN CHILDREN - EFFECT ONPULMONARY PERFUSION

Early pulmonary decortication was performed on 66 of 137 children with postpneumonic empyema, while 71 received conventional treatment. The mean age of the 66 patients with decortication was 5.5 years (range 6 months-14 years). The empyema was left-sided in 34 and right-sided in 32. Decortication was performed when lung expansion was not obtained a fter 10-12 days of intercostal tube drainage, antibiotic therapy (guid ed by sensitivity tests of pleural fluid) and pleural irrigation. Scin tigraphy showed loss of pulmonary perfusion on the side of empyema to be 65% +/- SD 20 (25-98)% before decortication in the 23 tested patien ts. In ten of them the test was repeated after surgery and showed;sign ificant (p < 0.001) diminution of the perfusion defect, from 57 +/- 6. 8 (25-84)% to 4 +/- 2.6 (0-8)%. The hospital stay was significantly (p < 0.001) shorter for the surgically treated than for the classically managed patients, viz. 19.5 +/- 4 (13-36) days vs 73.6 +/- 14 (34-110) days. Early decortication thus had beneficial effects on pulmonary pe rfusion and hospital stay.