An empyema is a collection of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscess, chest trauma, or surgery. Symptoms include reduced or absent breath sounds and chest pain. Diagnosis involves CT scan showing fluid collections and diagnostic thoracentesis extracting cloudy or purulent fluid. Treatment includes antibiotics, drainage via chest tube or thoracotomy, and lung-expanding breathing exercises. While open thoracotomy provides rapid resolution in children, less invasive options like thoracoscopy or fibrinolysis should be considered depending on the case.
An empyema is a collection of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscess, chest trauma, or surgery. Symptoms include reduced or absent breath sounds and chest pain. Diagnosis involves CT scan showing fluid collections and diagnostic thoracentesis extracting cloudy or purulent fluid. Treatment includes antibiotics, drainage via chest tube or thoracotomy, and lung-expanding breathing exercises. While open thoracotomy provides rapid resolution in children, less invasive options like thoracoscopy or fibrinolysis should be considered depending on the case.
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An empyema is a collection of thick, purulent fluid in the pleural space caused by bacterial pneumonia, lung abscess, chest trauma, or surgery. Symptoms include reduced or absent breath sounds and chest pain. Diagnosis involves CT scan showing fluid collections and diagnostic thoracentesis extracting cloudy or purulent fluid. Treatment includes antibiotics, drainage via chest tube or thoracotomy, and lung-expanding breathing exercises. While open thoracotomy provides rapid resolution in children, less invasive options like thoracoscopy or fibrinolysis should be considered depending on the case.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
purulent fluid within the pleural space, often with fibrin development & a loculated (walled-off) area where infection is located Causes/Risk Factors: Presence of bacterial pneumonia or lung abscess Penetrating chest trauma Hematogenous infection of the pleural space Nonbacterial infections Iatrogenic causes (after thoracic surgery or thoracentesis) Assessments with PE & NHH Signs & Symptoms: Assessments with PE & NHH Physical Exams: or absent breath sounds over affected area dullness on chest percussion fremitus Diagnostic & Lab Studies Computed Tomography (CT) scan – reveals large empyema collection with atelectic lobe and consolidation CT scan of chest showing empyema necessitans (long arrow), a chronic untreated empyema that has eroded through the thoracic cage and formed a subcutaneous abscess (short arrow) CT scan showing empyema with split pleura sign (enhancement of the thickened inner visceral and outer parietal pleura separated by a collection of pleural fluid) Diagnostic & Lab Studies Diagnostic Thoracentesis, under ultrasound guidance – extraction of a cloudy or frankly purulent fluid; little or no offense odor (aerobic pus); foul smelling (anaerobic pus) Diagnostic & Lab Studies Diagnostic Thoracentesis, under ultrasound guidance – fluid analysis Diagnostic Thoracentesis Pathophysiology Presence of Parapneumonic Effusion Release of inflammatory mediators ↑permeability of the capilliaries Attracts WBCs to the site Escape of albumin & other protein from the capillaries ↑ Pleural fluid Presence of free-flowing, protein rich pleural fluid (Stage I) Inflammation worsens Attracts more WBCs to the site Extensive purulent exudate production Initiation of fibroblastic activity (Stage II) Adherence of the two pleural membranes (Stage III) Formation of a “peel” Nursing Diagnosis Impaired Gas Exchange r/t compressed lung Acute Pain r/t infection of the pleura Risk for Activity Intolerance r/t hypoxia secondary to empyema Principles of Management Help the patient cope with the condition Instruct patient in lung- expanding breathing exercises to restore normal respiratory function Principles of Management Provide care specific to the method of drainage Instruct the patient & family on care of the drainage system & drain site, measurement & observation of drainage, s/sx of infection, and how & when to contact a health care provider Pharmacology Antibiotic, cephalosporin (second generation) – for bacterial infections; Cefuroxime (Zinacef) – for staphylococcal & streptococcal organisms; most often selected initial antibiotic (Adult: 750-1500mg IV q8h; Pedia: 150mg/kg/d IV divided q8h) Pharmacology Antibiotics,anaerobic infections – an aspiration or likely anaerobic infection is the cause of the pneumonia Clindamycin (Cleocin) – for gram- positive organisms & anaerobes (Adult: 600-1200mg/d IV/IM divided q6-8h; Pedia: 25-40mg/kg/d IV divided q6-8h) Pharmacology Antibiotic, Miscellaneous – when methicillin-resistant S.aureus is suspected. Vancomycin (Vancocin, Vancoled) – a glycopeptide agent for gram- positive (Adult: 500mg IV q6h or 1g IV q12h- not to exceed infusion rate of 10mg/min; Pedia: 40mg/kg/d IV divided tid/qid) Pharmacology Thrombolytic Agents – convert plasminogen to plasmin, leading to clot lysis. Alteplase (Activase) – binds to fibrin in a thrombus & converts the entrapped plasminogen to plasmin, initiating local fibrinolysis. (administered intrapleural via chest tube) Surgery/Special Procedures AntibioticTherapy – prescribed in large doses based on the causative organism Thoracentesis – for small fluid volume w/c is not too purulent or thick Surgery/Special Procedures Tube Thoracostomy – for loculated or complicated pleural effusions Open Chest Drainage via Thoracotomy, including potential rib resection – for thickened pleura & removal of the underlying diseased pulmonary tissue BioEthics
Is open thoracotomy
still a good treatment option for the management of empyema in children? Open thoracotomy remains an excellent option for management of stage II–III empyema in children. When open thoracotomy is performed in a timely manner there is low morbidity and it provides rapid resolution of symptoms with a short hospital stay. However, delayed referrals may result in advanced pulmonary sepsis and a protracted clinical course. The late results are encouraging. Use of thoracoscopy or fibrinolysis should be considered on the basis of their own merit, not on the assumption of probable adverse outcomes after thoracotomy. THAT’S ALL, THANK YOU!!!