Is chest drain insertion and fibrinolysis therapy equivalent to video-assisted thoracoscopic surgery to treat children with parapneumonic effusions?

Scenario A 12-year-old boy, previously fit and well, presents to his local paediatric emergency department after 5 days of fever and a cough, and 2 days of increasing difficulty breathing. His oxygen saturation is 90% in air, and he requires 2 L of oxygen via nasal cannula. He is started on broad-spectrum antibiotics and further investigations are arranged. A chest X-ray is performed and shows a large left-sided pleural effusion. An ultrasound demonstrates the effusion is complex and loculated, with underlying lung consolidation, in keeping with a stage II parapneumonic effusion. The medical team wonders whether insertion of a chest drain and fibrinolysis (CDF) or video-assisted thoracoscopic surgery (VATS) would be the most appropriate next step. Structured clinical question Is CDF therapy equivalent to VATS to treat children with parapneumonic effusions? Search strategy Search terms including keywords such as "empyema", "parapneumonic effusion", "thoracostomy", "chest...

Source: Archives of Disease in Childhood - October 30, 2023 Category: Pediatrics Authors: Bell, A. C. J., Baker, C., Duret, A. Tags: ADC Archimedes Source Type: research