PubMed · 9987403
This article discusses different types of pneumothorax and aspects of management, including physiotherapy and the insertion and removal of chest drains.
Explore connections, maps & timelines
A Gallon. Pneumothorax.. https://doi.org/10.7748/ns1998.11.13.10.35.c2564
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Pleural drainage becomes a vital measure to restore physiological conditions in cases of loss of pleural negative pressure, regardless its etiology. Therefore, it is not surprising that hardly any evidence based publications on this topic are available. For the treatment of pleural empyema,the history of pleural drainage goes back to antiquity.Nowadays, quite a number of synonymously used terms are wrongly employed instead of the correct terms of thoracic or pleural drainage. Indications for placing a pleural drainage are: pneumothorax, pleural effusion, pleural empyema,hemothorax and chylothorax. As a standard method, it is recommended that the pleural drainage be placed in the fifth or sixth intercostal space in the anterior axillary line. It is not advisable to use a closed insertion with the help of a trocar due to the significantly increased risk of injury. The insertion of a pleural drainage when correctly placed is a safe procedure; rare typical complications involve the wrong placement of the drainage, hemorrhage or infection like pleural empyema. The complication rate, however, does not exceed 3%.
OBJECTIVE: The optimal treatment of pediatric empyema remains controversial. The objective of this study is to compare the use of conventional management versus primary thoracoscopic drainage and decortication in children with empyema. METHODS: Conventional management has consisted of chest drain insertion under general anesthesia plus intravenous antibiotics. Thoracoscopic drainage and decortication has consisted of primary thoracoscopic drainage and decortication plus antibiotics. The clinical course of 54 patients treated conventionally between 1989 and 1997 was compared with that of 21 patients treated by means of thoracoscopic drainage and decortication between September 2000 and September 2001. RESULTS: Results of the study demonstrated that patients in the drainage-decortication group had fewer invasive interventions per patient than those in the conventional management group (1.0 vs 1.26). Patients undergoing thoracoscopic drainage and decortication also had significantly shorter durations of intravenous antibiotic therapy (7.6 +/- 1.2 vs 18.2 +/- 7.5 days), chest tube drainage (4.0 +/- 0.5 vs 10.2 +/- 6.1 days), and hospital stays (7.4 +/- 0.8 vs 15.4 +/- 7.4). Moreover, there were no open thoracotomies and decortications in the thoracoscopic drainage and decortication group, whereas in the conventional management group 39% (21/54) of patients underwent an open procedure. CONCLUSION: Although the 2 groups were not prospectively randomized and they were treated in different time periods, the results of this study support the use of thoracoscopic surgery as the primary therapeutic modality in children presenting with pleural empyema. This strategy appears to offer significant benefits over conventional treatment in terms of duration of treatment and the need for more invasive surgery.