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ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE

Year 2022, Volume: 24 Issue: 3, 436 - 442, 31.12.2022
https://doi.org/10.24938/kutfd.1057049

Abstract

Objective: This study aimed to investigate the possible complications, outcomes and course of ultrasonography (USG)-guided percutaneous pleural effusion drainage (PEPED) treatment with underlying etiology of effusion in neonates and infants.
Material and Methods: In 31 patients aged 0-2 years hospitalized in the neonatal or pediatric intensive care unit, 45 catheters were inserted for USG-guided PEPED in a total of 40 sessions. Of these, a 6.3F 25 cm pigtail drainage catheter was inserted in 23 (57.5%) of our patients using the Seldinger method and in 17 (42.5%) using the trocar method. The sample fluid was biochemically classified as transudate, exudate, empyema and chylothorax. The duration of inserted catheter and type of fluid was studied along with etiological reasons for effusions.
Results: Of our 31 patients, 17 were male (54.8%) and 14 were female (45.2). The weeks of birth ranged from 25.1 to 41 weeks, with a mean of 35.55±4.22 weeks. The retention time of drainage catheters ranged from 1 to 18 days, with a mean of 6.5±4.02 days. We compared the retention time of inserted catheters between different preterm and mature groups. Besides, the various fluid characters in the postoperative patient group were compared in the context postoperative day period.
Conclusion: Catheter dwell time does not change with different levels of neonatal maturity. In neonates and infants with a history of surgery, the effusion transforms into chylothorax from hemothorax over time. Bedside USG-guided PEPED treatment for refractory pleural effusion in neonates and infants is highly safe and effective with low complication rates.

Supporting Institution

BAŞKENT ÜNİVERSİTESİ TIP FAKÜLTESİ

Project Number

KA21/415

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References

  • Rix-Trott K, Byrnes CA, Gilchrist CA, Matsas R, Walls T, Voss L, et al. Surveillance of pediatric parapneumonic effusion/empyema in New Zealand. Pediatr Pulmonol 2021; 56(9):2949-57.
  • Doski JJ, Lou D, Hicks BA, Megison SM, Sanchez P, Contidor M, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg 2000; 35(2):265-8.
  • Furuya-Meguro ME, Mejia-Arangure JM, Martinez-Martinez BE, Villalpando-Canchola R, Fuentes-Arellano SA. Pneumonia complicated with empyema in children, to operate or not? Risk factors for surgery and review of the literature. Gac Med Mex 2000; 136(5):449-54.
  • Hilliard TN, Henderson AJ, Langton Hewer SC. Management of parapneumonic effusion and empyema. Arch Dis Child 2003; 88(10):915-7.
  • Hoffer FA, Bloom DA, Colin AA, Fishman SJ. Lung abscess versus necrotizing pneumonia: implications for interventional therapy. Pediatr Radiol 1999;29(2):87-91.
  • Martinez L, Rivas S, Hernandez F, Avila LF, Lassaletta L, Murcia J, et al. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003;38(5):685-9.
  • Roberts JS, Bratton SL, Brogan TV. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest 1998;114(4):1116-21.
  • Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med 2003;4(1):39-43.
  • Kilic N, Celebi S, Gurpinar A, Hacimustafaoglu M, Konca Y, Ildirim I, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18(1):21-3.
  • Light RW, Macgregor MI, Luchsinger PC, Ball WC, Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972;77(4):507-13.
  • Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 1980; 55(11):700-4.
  • Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR. The clinical course and management of thoracic empyema. QJM 1996;89(4):285-9.
  • Jaffe A, Calder AD, Owens CM, Stanojevic S, Sonnappa S. Role of routine computed tomography in paediatric pleural empyema. Thorax 2008;63(10):897-902.
  • Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev 2002;3(4):292-7.
  • Utine GE, Ozcelik U, Kiper N, Dogru D, Yalcn E, Cobanoglu N, et al. Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years. Turk J Pediatr 2009; 51(3):214-9.
  • Yang S, Wang J, Li J, Huang K, Yang Y. Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review. J Int Med Res 2021; 49(5):3000605211010073.
  • Stevenson DA, Pysher TJ, Ward RM, Carey JC. Familial congenital non-immune hydrops, chylothorax, and pulmonary lymphangiectasia. Am J Med Genet A 2006;140(4): 368-72.
  • Van Aerde J, Campbell AN, Smyth JA, Lloyd D, Bryan MH. Spontaneous chylothorax in newborns. Am J Dis Child 1984;138(10):961-4.
  • Van Straaten HL, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur J Pediatr 1993;152(1):2-5.
  • Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 2012;47(11):2101-10.
  • Margau R, Amaral JG, Chait PG, Cohen J. Percutaneous thoracic drainage in neonates: catheter drainage versus treatment with aspiration alone. Radiology 2006;241(1): 223-7.

YENİDOĞAN VE İNFANT YAŞ GRUBUNDA ULTRASONOGRAFİ KILAVUZLUĞUNDA PERKÜTAN PLEVRAL EFÜZYON DRENAJI: TEK MERKEZ DENEYİMİ

Year 2022, Volume: 24 Issue: 3, 436 - 442, 31.12.2022
https://doi.org/10.24938/kutfd.1057049

Abstract

Amaç: Plevral efüzyon infant yaş grubunda ağır bir morbidite ve mortalite sebebi olup plevral efüzyonun en sık nedeni enfeksiyöz hastalıklardır. Ancak ameliyat sonrası dönem, kardiyak ve romatolojik etkenler de persistan plevral efüzyon nedenleri olabilir. Biz bu araştırmamızda ultrasonografi kılavuzluğunda perkütan plevral efüzyon drenajı tedavisinin seyrini, olası komplikasyonlarını ve sonuçlarını etiyoloji ile bir arada değerlendirmeyi amaçladık.

Gereç ve Yöntem: 30 Nisan 2014 ile 30 Ağustos 2021 tarihleri arasında, 0-2 yaş grubunuda olup yenidoğan veya pediatrik yoğun bakımda yatan 31 hastamıza toplam 40 seansta, USG kılavuzluğunda perkütan plevral efüzyon drenajı (PEPED) amacıyla 45 kateter takıldı. Bu hastalarımızdan 23’üne Seldinger yöntemiyle (%57.5), 17’sine trokar yöntemiyle (%42.5) 6,3F 25 cm pigtail drenaj kateteri takılmış olup gelen mayi biyokimyasal olarak transüda, eksüda, ampiyem ve şilotoraks olarak sınıflandırıldı. Kateterlerin takılı olduğu süreç, kaldığı gün sayısı ve mayi karekteri, etiyolojik nedenlerle bir arada incelendi.

Bulgular: Otuz bir hastamızın 17’si erkek (%54.8), 14’ü kız (%45.2) idi. Doğum haftaları 25,1 – 41 arasında olup ortalama 35.55±4.22 idi. Takılan drenaj kateterlerinin kalış süresi 1-18 gün arasında olup ortalama 6.5±4.02 gün idi. Kateterlerin kalış süresini gruplar arasında kıyaslamak ve post-operatif hasta grubunda mayi karakteri ile post-operatif dönemde kateterin takıldığı gün arasında istatistiksel olarak anlamlı fark olup olmadığını görmek için normallik testlerini takiben Bağımsız Örneklem T-testi yapıldı.

Sonuç: İnfant yaş grubunda refrakter plevral efüzyonun tedavisinin, özellikle aspirasyon veya medikasyon ile yeterli olmadığı durumlarda, perkütan plevral efüzyon drenajı amacıyla hasta başında USG kılavuzuğunda drenaj kateteri yerleştirmek son derece güvenli bir yöntem olup komplikasyon ihtimali son derece düşük ve oldukça etkili bir yöntemdir.

Project Number

KA21/415

References

  • Rix-Trott K, Byrnes CA, Gilchrist CA, Matsas R, Walls T, Voss L, et al. Surveillance of pediatric parapneumonic effusion/empyema in New Zealand. Pediatr Pulmonol 2021; 56(9):2949-57.
  • Doski JJ, Lou D, Hicks BA, Megison SM, Sanchez P, Contidor M, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg 2000; 35(2):265-8.
  • Furuya-Meguro ME, Mejia-Arangure JM, Martinez-Martinez BE, Villalpando-Canchola R, Fuentes-Arellano SA. Pneumonia complicated with empyema in children, to operate or not? Risk factors for surgery and review of the literature. Gac Med Mex 2000; 136(5):449-54.
  • Hilliard TN, Henderson AJ, Langton Hewer SC. Management of parapneumonic effusion and empyema. Arch Dis Child 2003; 88(10):915-7.
  • Hoffer FA, Bloom DA, Colin AA, Fishman SJ. Lung abscess versus necrotizing pneumonia: implications for interventional therapy. Pediatr Radiol 1999;29(2):87-91.
  • Martinez L, Rivas S, Hernandez F, Avila LF, Lassaletta L, Murcia J, et al. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003;38(5):685-9.
  • Roberts JS, Bratton SL, Brogan TV. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest 1998;114(4):1116-21.
  • Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med 2003;4(1):39-43.
  • Kilic N, Celebi S, Gurpinar A, Hacimustafaoglu M, Konca Y, Ildirim I, et al. Management of thoracic empyema in children. Pediatr Surg Int 2002;18(1):21-3.
  • Light RW, Macgregor MI, Luchsinger PC, Ball WC, Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972;77(4):507-13.
  • Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 1980; 55(11):700-4.
  • Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR. The clinical course and management of thoracic empyema. QJM 1996;89(4):285-9.
  • Jaffe A, Calder AD, Owens CM, Stanojevic S, Sonnappa S. Role of routine computed tomography in paediatric pleural empyema. Thorax 2008;63(10):897-902.
  • Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev 2002;3(4):292-7.
  • Utine GE, Ozcelik U, Kiper N, Dogru D, Yalcn E, Cobanoglu N, et al. Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years. Turk J Pediatr 2009; 51(3):214-9.
  • Yang S, Wang J, Li J, Huang K, Yang Y. Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review. J Int Med Res 2021; 49(5):3000605211010073.
  • Stevenson DA, Pysher TJ, Ward RM, Carey JC. Familial congenital non-immune hydrops, chylothorax, and pulmonary lymphangiectasia. Am J Med Genet A 2006;140(4): 368-72.
  • Van Aerde J, Campbell AN, Smyth JA, Lloyd D, Bryan MH. Spontaneous chylothorax in newborns. Am J Dis Child 1984;138(10):961-4.
  • Van Straaten HL, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur J Pediatr 1993;152(1):2-5.
  • Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 2012;47(11):2101-10.
  • Margau R, Amaral JG, Chait PG, Cohen J. Percutaneous thoracic drainage in neonates: catheter drainage versus treatment with aspiration alone. Radiology 2006;241(1): 223-7.
There are 21 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Özgün Araştırma
Authors

Çağrı Kesim 0000-0002-8964-291X

Özgür Özen 0000-0001-7122-4130

Project Number KA21/415
Publication Date December 31, 2022
Submission Date January 12, 2022
Published in Issue Year 2022 Volume: 24 Issue: 3

Cite

APA Kesim, Ç., & Özen, Ö. (2022). ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 24(3), 436-442. https://doi.org/10.24938/kutfd.1057049
AMA Kesim Ç, Özen Ö. ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE. Kırıkkale Uni Med J. December 2022;24(3):436-442. doi:10.24938/kutfd.1057049
Chicago Kesim, Çağrı, and Özgür Özen. “ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24, no. 3 (December 2022): 436-42. https://doi.org/10.24938/kutfd.1057049.
EndNote Kesim Ç, Özen Ö (December 1, 2022) ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24 3 436–442.
IEEE Ç. Kesim and Ö. Özen, “ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE”, Kırıkkale Uni Med J, vol. 24, no. 3, pp. 436–442, 2022, doi: 10.24938/kutfd.1057049.
ISNAD Kesim, Çağrı - Özen, Özgür. “ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24/3 (December 2022), 436-442. https://doi.org/10.24938/kutfd.1057049.
JAMA Kesim Ç, Özen Ö. ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE. Kırıkkale Uni Med J. 2022;24:436–442.
MLA Kesim, Çağrı and Özgür Özen. “ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 24, no. 3, 2022, pp. 436-42, doi:10.24938/kutfd.1057049.
Vancouver Kesim Ç, Özen Ö. ULTRASONOGRAPHY GUIDED PERCUTANEOUS PLEURAL EFFUSION DRAINAGE IN NEONATES AND INFANTS: A SINGLE-CENTER EXPERIENCE. Kırıkkale Uni Med J. 2022;24(3):436-42.

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