Online ISSN: 2515-8260

Keywords : Empyema


A clinical study of pediatric patients requiring inter-costal drainage tube at a tertiary care centre in central India

Shashikant Patidar, Prateek Prajapati, Chayan Chakma, Naresh Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 508-516

Introduction: Intercostal drainage (ICD) tubes are indicated to drain clinically
undesired substances such as air, excess fluid, blood, chyle or pus from the intrathoracic
space. There are very few studies on pediatric patients managed with intercostal
drainage tube insertion for different indications.
Aims: To study the clinico-epidemiological profile, indications, complications and
outcomes of pediatric patients admitted in Pediatric Intensive care unit who were
managed with ICD tube insertion.
Material and Methods: Records of pediatric patients from Pediatric intensive care unit
(PICU) of Shyam Shah Medical college Madhya Pradesh during a period of one year i e
from July 2020 to June 2021 was collected and analysed prospectively.
Results: a total 25 patients were included in the study (male:female= 1.27:1; mean age
4.9± 3.7 years). Common clinical presentation of the patients were fever (n=18, 72%)
followed by fast breathing (n=11, 44%). Mean duration of stay was 18.7±11.7 days.
Common indications for ICD tube were pyothorax (n=8, 32%), pyopneumothorax,
empyema and pneumothorax (n=4, 16% each). 80 % cases were unilateral and 28%
required blood transfusion and inotropes for shock. Most common pathogen isolated
from cultures was staphylococcus aureus (>75%). 11 patients were started with
antitubercular treatment. In our study the mortality was 24%.
Conclusion: In this study, Staphylococcus aureus was the most common organism
isolated from culture whereas 44% cases were treated with antitubercular treatment
that reflects how common tubercular pleural effusions are in pediatric age group in this
area. Early diagnosis and treatment is the key of management. More extensive studies
are required in this topic of interest.

MANAGEMENT OF PEDIATRIC EMPYEMA WITH INTRAPLEURAL STREPTOKINASE : RANDOMISED CONTROL TRIAL

Dr. Abhijit shinde; Dr. Sunil NathaMhaske; Dr. Ramesh Kothari; Dr. Shreya Bhate

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 5712-5720

Parapneumonic pleural effusions may occur in 36–57% of patients with pneumonia and about 15–20% of this accumulated fluid becomes infected resulting in empyema [1,2)Empyema generally occurs in children after pneumonia of acute bacterial origin and it is generally associated with significant morbidity and mortality.Injection of various fibrinolytic agents like streptokinase, urokinase in the intrpleural space are increasingly being used for the management of such conditions.(7-10)The main aim of this study was analysing role of adding intrapleural streptokinase in the management of childhood empyema.Methodology:The present retrospective study was conducted in our Institute during a period of 2 years. The study consisted of 20 subjects that were admitted to the hospital with the complaint of pneumonia complicated by empyema.. Chest tube placement were done by pediatricians.Half of the patients received intrapleural streptokinase. The dose of streptokinase was 2,50,000 U in 100 ml of saline.The criteria for comparison were - duration of chest tube drainage, stay in hospital, fever and decrease in incidence of hospital stay were considered as successful treatment.All the data was arranged in a tabulated form and was analysed using Epi info software version 7.1.2. Chi square test and student t test was used for comparison. Probability value of less than 0.05 was considered significant. RESULT: The study enrolled total of 20 subjects, out of these 10 belonged to conventional group and 10 were administered intrapleuralstreptokinase.Both groups compared &There was no significant difference in the variables between the two groups as the p value was more than 0.05. CONCLUSION: From this study it is clear that addition of intrapleural streptokinase along with the conventional therapy provides no special benefit.In complicated cases fibrinolytics can be used as additional therapy.