Management of parapneumonic collections in infants and children

Background/Purpose: Video-assisted thoracoscopic surgery (VATS) has a recog nized role in treatment of empyema thoracis. The purpose of this report is to show the Value of initial VATS as the primary treatment of parapneumonic collections. Methods: A retrospective review was done of 139 children who required surgi cal consultation for parapneumonic collections between January 1992 and Jul y 1998. Management options were (M1) thoracentesis, chest tube drainage, or fibrinolytic therapy and delayed thoracotomy for unresolved collections; ( M2) thoracentesis, chest tube drainage, fibrinolytic therapy with delayed V ATS if the child remained ill; or (M3) primary VATS. Comparative data inclu ded age, du ration of prehospital illness, oxygen requirements, white blood cell count, bacterial culture results, number of procedures performed per patient, duration of chest tube drainage, complications, and length of stay . Kruskal-Wallis 1-way analysis was used, with significance at P less than .05. Results: A total of 60 children were treated by M1, 38 by M2, and 41 by M3. Age, duration of prehospital illness, oxygen requirements, white blood cel l count, bacterial culture results, and complication rates were comparable. The median length of stay was 12 days for M1, 11 days for M2, and 7 days f or M3, with M3 significantly shorter at P <.001. The number of procedures w as a median of 2 in M1, 2 in M2, and 1 in M3, with M3 significantly fewer a t P <.001. Duration of chest tube drainage was a median 5 days for M1 and 3 days for M2 and M3, with M1 significantly longer at P <.001. There were 9 thoracotomies in the M1 group, 3 in the M2 group, and none in the M3 group. One child in M3 required a second VATS. Conclusions: Primary VATS has significantly decreased the number of procedu res, duration of chest tube drainage and length of stay for children with p arapneumonic effusions. Primary VATS appears to be of value in management o f bacterial pneumonia with effusion. J Pediatr Surg 35:265-270. Copyright ( C) 2000 by W.B. Saunders Company.