The controversial role of decortication in the management of pediatric empyema
Kosloske, A.M.; Cartwright, K.C.
Journal of Thoracic and Cardiovascular Surgery 96(1): 166-170
1988
ISSN/ISBN: 0022-5223 PMID: 3260313 Document Number: 321090
Open surgical procedures for pleural empyema remain controversial in children. The pediatric literature generally recommends a prolonged trial of antibiotics and closed tube thoracostomy drainage. We report a favorable experience with a selective approach to open drainage in 22 children, many of whom had an empyema already organizing at admission. Open drainage was considered in children whose conditions failed to improve after 3 to 5 days of therapy with antibiotics and closed drainage. The method of drainage was selected according to the pathologic phase of the empyema: five children with fibrinopurulent empyema were successfully managed by limited decortication, and 17 with organizing empyema received decortication. Clinical improvement was usually dramatic; most of the children became a febrile by postoperative day 3 and were discharged by postoperative day 10. There were no deaths. Three children (14%) had complicatons of postoperative air leak or infection. Streptococcus pneumoniae (5) and Hemophilus influenzae (3) were the most common single pathogens. The presence of anaerobic bacteria in 8 of 22 children (36%) was associated with rapid organization of the empyema and the need for decortication. Decortication procedures have a low risk and are effective in children with empyema. They should be considered as definitive therapy, rather than as a last resort.