Lung function in children following empyema

Article Abstract:

The standard treatment for children with empyema (a collection of pus in a cavity of the body, particularly the chest) is tube drainage of the cavity using a closed system, and continuous antibiotics. This treatment results in thorough drainage of the empyema, with reduced mortality and shorter illness and hospitalization. In adults, this treatment has the long-term effect of reducing the likelihood of restrictive lung disease, but this long-term effect is less clear in children. Some observers have suggested that chest tubes may not be necessary if adequate antibiotic treatment and supportive care is given. A study was undertaken of 15 children who had recovered from empyema to better describe the long-term outcome of these patients. There were seven children who had undergone chest tube drainage (group 1), and eight children who had not (group 2); both groups received intravenous antibiotics. Children who had chest tube placement were hospitalized longer and received antibiotic therapy for a longer duration than did children treated with antibiotics alone. The duration of fever was similar in both groups. The average interval from empyema to follow-up was five years for group 1 and six years for group 2. The children were evaluated by means of spirometry (which tests the air capacity of the lungs) at rest and measurement of heart-lung response to exercise. No child showed restrictive lung changes on spirometry; 7 of the 15 children had reduced forced expiratory volume, which indicates mild airway obstruction. These mild obstructive abnormalities occurred with equal frequency in both patient groups. The findings suggest that the chest tube drainage is not required to ensure long-term recovery, but may be indicated when there is rapidly growing infection of the chest cavity or slow improvement with only antibiotic treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Chest intubation

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Use of purified streptokinase in empyema and hemothorax

Article Abstract:

Collections of protein-containing fluid, blood, or pus located in the pleural space (space between the lung and the chest wall) need to be removed. If this fluid is not drained, the retained blood, known as hemothorax, can result in empyema (pus in the pleural cavity) with a significant risk of death. Initial fluid drainage is performed by placement of a simple tube, called a chest tube, within the pleural space. Thoracotomy (open incision into the chest) or rib resection is often performed if the tube drainage is not successful. A possible alternative to early thoracotomy is the use of a purified streptokinase solution that is administered within the pleural space as an adjunct to chest tube drainage. Streptokinase may be effective in cleansing the pleural space of residual protein deposits and enhancing the drainage process. A report is presented of 14 patients treated with streptokinase for unresolved pleural cavity collections. Success was achieved in evacuating the pleural space of fluid in 13 of the 14 patients treated with chest tube drainage and injection of streptokinase solution; the one patient who did not respond to this approach underwent thoracotomy. There were no significant complications. Two deaths occurred, but were unrelated to streptokinase or empyema. It is concluded that the use of streptokinase injected into the pleural cavity is safe and effective for removing retained fluid collections in the pleural space, and is a useful adjunct to chest tube drainage; this approach may allow surgery to be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Streptokinase, Thoracentesis, Hemothorax

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Passive smoke exposure impairs recovery after hospitalization for acute asthma

Article Abstract:

Environmental exposure to tobacco smoke may delay recovery from severe asthma attacks in children. Researchers followed 22 children who had been hospitalized with asthma attacks of whom 11 were exposed to tobacco smoke in the home and 11 were not. During the month after hospital discharge, 9 of the 11 children in the no smoke-exposure group experienced less than one symptomatic day per week versus only 3 children in the smoke exposure group. Bronchodilator use in the no smoke-exposure group declined during follow up whereas use did not decline in the smoke exposure group.

Health aspects, Environmental aspects, Sick children, Asthma in children, Childhood asthma, Passive smoking

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