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Community-Acquired Pneumonia (CAP) - Drainage Options for Parapneumonic Effusion in Pediatric Patient

Purpose: To manage a pediatric patient with community-acquired pneumonia (CAP) who has a parapneumonic effusion.

Description

Bradley et al outlined options for the drainage of a parapneumonic effusion in a pediatric patient with community-acquired pneumonia (CAP). The authors are from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.


 

Patient selection: CAP with parapneumonic effusion

 

Parameters:

(1) size of effusion

(2) nature (simple vs complicated)

 

A small effusion without complications will usually resolve with antibiotic therapy and does not have to be drained.

 

Drainage tends to be needed for:

(1) moderate or large effusions

(2) loculated fluid

(3) respiratory distress

(4) purulent effusion (empyema)

 

Drainage options:

(1) chest tube alone (if without empyema and/or loculations)

(2) chest tube with fibrinolytic therapy

(3) video-assisted thoracoscopic surgery (VATS)

 

Fibrinolytic regimens:

(1) St Peter et al

(2) Hawkins et al

(3) Sonnappa et al

 

Parameters

St Peter

Hawkins

Sonnappa

fibrinolytic agent

tissue plasminogen activator

tissue plasminogen activator

urokinase

dosing (made up in normal saline, NS)

4 mg in 40 mL NS

MIN(0.1 mg/kg, 3 mg) in 10-30 mL

10,000 U in 10 mL if under 1 year old; 40,000 U in 40 mL if over 1 year old

dwell time

1 hour

0.75 to 1 hour

4 hours

suction on chest-tube (in cm H2O)

-20

-20 to –25

-10 to –20

number of times done

3

9

6

dosage intervals

24 hours

8 hours

12 hours

 

where:

• During the dwell time there is no suction on the chest tube.

• The number of doses and the dosage intervals all add up to 3 days.

• In the Hawkins protocol the 3 mg is reached at a body weight of 30 kg.

 


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Specialty

Objective

ICD-10