Indications for VATS or Open Decortication in Pediatric Patient with CAP and Chest Tube

Patient selection: pediatric patient with CAP and a chest tube for draining parapneumonic fluid

Indications for an additional intervention:

(1) ongoing presence of a moderate or large pleural effusion

(2) ongoing respiratory compromise

(3) status post 2-3 days of chest tube with or without fibrinolytic therapy

Additional intervention – one of the following:

(1) video-assisted thoracoscopic surgery (VATS, preferred)

(2) open debridement with decortication

A chest CT should be performed to evaluate pleural fluid drainage, identify loculated fluid collections and locate necrotizing pneumonia.