Tratamiento de los derrames pleurales paraneumónicos
Management of parapneumonic pleural effusions
O. Asensio de la Cruza, J. Blanco Gonzálezb, A. Moreno Galdóc,
, J. Pérez Fríasd, A. Salcedo Posadase, L. Sanz Borrellf, Grupo de Trabajo de Técnicas Especiales en NeumologíaPediátrica de la Sociedad Española de Neumología Pediátrica g
Autor para correspondencia
amgaldo@cs.vhebron.es
Correspondencia: Unidad de Neumología Pediátrica y Fibrosis Quística. Hospital Materno-Infantil Vall d'Hebron. P.° Vall d'Hebron, 119-129. 08035 Barcelona
Correspondencia: Unidad de Neumología Pediátrica y Fibrosis Quística. Hospital Materno-Infantil Vall d'Hebron. P.° Vall d'Hebron, 119-129. 08035 Barcelona
a Servicios de Pediatría Corporació Sanitària Parc Taulí Sabadell, Barcelona
b Servicios de Pediatría Hospital Universitario Príncipe deAsturias, Alcalá de Henares Madrid
c Servicios de Pediatría Hospital Materno-Infantil Vall d'Hebron Barcelona
d Servicios de Pediatría Hospital Materno-Infantil Carlos Haya Málaga
e Servicios de Pediatría Hospital Infantil Universitario Niño Jesús Madrid
f Servicios de Pediatría Hospital Sant Joan de Reus Reus. Tarragona
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Tarragona" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Unidad de Neumología Pediátrica y Fibrosis Quística. Hospital Materno-Infantil Vall d'Hebron. P.° Vall d'Hebron, 119-129. 08035 Barcelona" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Management of parapneumonic pleural effusions" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-11-30" "fechaAceptado" => "2000-11-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186598" "palabras" => array:7 [ 0 => "Neumonías" 1 => "Derrame pleural paraneumónico" 2 => "Empiema" 3 => "Drenaje pleural" 4 => "Fibrinolíticos" 5 => "Toracoscopia" 6 => "Niños" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186597" "palabras" => array:7 [ 0 => "Pneumonia" 1 => "Parapneumonic pleural effusion" 2 => "Empyema" 3 => "Pleural drainage" 4 => "Fibrinolytics" 5 => "Thoracoscopy" 6 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las neumonías son una de las causas más frecuentes de derrame pleural en los niños. El 0,6-2 % de las neumonías se complican con empiema y aproximadamente el 40% de las neumonías que precisan hospitalización en niños presentan derrame pleural. En los últimos años, <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> es el germen aislado con mayor frecuencia.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tratamiento se basa en el empleo adecuado y precoz de antibióticos, técnicas de imagen, toracocentesis, drenaje pleural, fibrinolíticos, toracoscopia y toracotomía.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La colocación de un drenaje pleural está indicada de forma precoz en las siguientes situaciones: presencia de pus en el espacio pleural, tinción de Gram positiva del líquido pleural, glucosa del líquido pleural inferior a 50 mg/dl, pH del líquido pleural inferior a 7, presencia de septos o tabiques en el líquido pleural en la ecografía.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La instilación local de fibrinolíticos puede disminuir la necesidad de tratamiento quirúrgico, con una eficacia entre el 38 y el 100 %, según lo avanzado del estadio del derrame. El desbridamiento por toracoscopia es útil en fase fibrinopurulenta con tabicaciones y adherencias, con resultados favorables según la precocidad de su realización, entre el 30-100 %</p>" ] "en" => array:1 [ "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pleural effusion in children is most often due to bacterialpneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40 % of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50 mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100 %, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100 % of patients, also depending on the effusion stage</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">Miembros del grupo de trabajo</span>: D. Álvarez Gil (Hospital Infanta Margarita, Cabra, Córdoba); V. Alzina de Aguilar (Clínica Universitaria de Navarra, Pamplona); A. Andrés Martín (Hospital Universitario de Valme, Sevilla); C. Antelo Landeira (Hospital Universitario La Paz, Madrid); O. Asensio de la Cruz (Corporació Sanitària Parc Taulí, Sabadell, Barcelona); I. Barrio Gómez de Agüero (Hospital Universitario La Paz, Madrid); J. Blanco González (Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid); M. Bermejo Pastor (Hospital Materno-Infantil de Badajoz); A. Bonillo Perales (Hospital Torrecárdenas, Almería); M. Bosque García (Corporació Sanitària Parc Taulí, Sabadell, Barcelona); G. Cabrera Roca (Hospital Universitario Materno-Infantil, Las Palmas de Gran Canaria); M. Carrasco Zalvide (Hospital Juan Ramón Jiménez, Huelva); I. Cortell Aznar (Hospital Universitario La Fe, Valencia); J. Elorz Lambarri (Hospital de Cruces, Baracaldo, Vizcaya); A. Escribano Montaner (Hospital Clínico Universitario, Valencia); J. Figuerola (Hospital de Manacor, Baleares); M.D. Frías Morales (Madrid); D. Gómez-Pastrana Durán (Hospital de Jerez, Jerez de la Frontera, Cádiz); C. Landaluce Ugarte (Hospital Txagorritxu, Vitoria); S. Liñán Cortés (Hospital Materno-Infantil Vall d'Hebron, Barcelona); M. Machuca Contreras (Hospital Virgen del Rocío, Sevilla); C. Martínez (Hospital Universitario La Paz, Madrid); A. Moreno Galdó (Hospital Materno-Infantil Vall d'Hebron, Barcelona); C. Oliva Hernández (Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Canarias); M.T. Pascual Sánchez (Hospital de Sant Joan, Reus, Tarragona); L. Pardos Rocamora (CAP Balaguer, Lleida); J. Pérez Frías (Hospital Materno-Infantil Carlos Haya, Málaga); G. Pérez Pérez (Hospital Universitario Virgen de la Macarena, Sevilla); E. Pérez Ruiz (Hospital Materno-Infantil Carlos Haya, Málaga); C. Reverté Bover (CAP Amposta, Tarragona); A. Salcedo Posadas (Hospital Infantil Universitario Niño Jesús, Madrid); J. Sánchez Jiménez (Hospital de Sant Jaume, Calella, Barcelona); E. Sánchez Sánchez (CAP Premià de Mar, Barcelona); L. Sanz Borrell (Hospital de Sant Joan, Reus, Tarragona); A. Sequeiros González (Hospital Infantil Universitario Niño Jesús, Madrid); J. Sirvent Gómez (Complejo Hospitalario Juan Canalejo, La Coruña); J.M. Tabarés Lezcano (Hospital Cristal-Piñor, Orense); J.M. Torres Simón (Hospital de Palamós, Girona); M.I. Ubeda Sansano (CAP Godella, Valencia); J.R. Villa Asensi (Hospital Infantil Universitario Niño Jesús, Madrid).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fisiopatología de la pleura: manejo del derrame pleural" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Segado" 1 => "F. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 38 | 23 | 61 |
| 2024 Octubre | 609 | 179 | 788 |
| 2024 Septiembre | 638 | 159 | 797 |
| 2024 Agosto | 470 | 178 | 648 |
| 2024 Julio | 395 | 99 | 494 |
| 2024 Junio | 533 | 98 | 631 |
| 2024 Mayo | 481 | 112 | 593 |
| 2024 Abril | 465 | 111 | 576 |
| 2024 Marzo | 440 | 140 | 580 |
| 2024 Febrero | 569 | 148 | 717 |
| 2024 Enero | 667 | 109 | 776 |
| 2023 Diciembre | 562 | 107 | 669 |
| 2023 Noviembre | 580 | 200 | 780 |
| 2023 Octubre | 732 | 275 | 1007 |
| 2023 Septiembre | 405 | 182 | 587 |
| 2023 Agosto | 305 | 113 | 418 |
| 2023 Julio | 295 | 178 | 473 |
| 2023 Junio | 363 | 152 | 515 |
| 2023 Mayo | 471 | 163 | 634 |
| 2023 Abril | 319 | 91 | 410 |
| 2023 Marzo | 370 | 173 | 543 |
| 2023 Febrero | 273 | 86 | 359 |
| 2023 Enero | 283 | 121 | 404 |
| 2022 Diciembre | 443 | 75 | 518 |
| 2022 Noviembre | 324 | 132 | 456 |
| 2022 Octubre | 313 | 127 | 440 |
| 2022 Septiembre | 247 | 62 | 309 |
| 2022 Agosto | 192 | 109 | 301 |
| 2022 Julio | 187 | 88 | 275 |
| 2022 Junio | 166 | 54 | 220 |
| 2022 Mayo | 167 | 77 | 244 |
| 2022 Abril | 167 | 80 | 247 |
| 2022 Marzo | 146 | 94 | 240 |
| 2022 Febrero | 109 | 56 | 165 |
| 2022 Enero | 119 | 67 | 186 |
| 2021 Diciembre | 94 | 64 | 158 |
| 2021 Noviembre | 86 | 68 | 154 |
| 2021 Octubre | 105 | 73 | 178 |
| 2021 Septiembre | 75 | 65 | 140 |
| 2021 Agosto | 84 | 48 | 132 |
| 2021 Julio | 87 | 57 | 144 |
| 2021 Junio | 74 | 51 | 125 |
| 2021 Mayo | 101 | 32 | 133 |
| 2021 Abril | 172 | 100 | 272 |
| 2021 Marzo | 131 | 49 | 180 |
| 2021 Febrero | 122 | 34 | 156 |
| 2021 Enero | 114 | 45 | 159 |
| 2020 Diciembre | 76 | 32 | 108 |
| 2020 Noviembre | 53 | 23 | 76 |
| 2020 Octubre | 69 | 25 | 94 |
| 2020 Septiembre | 35 | 13 | 48 |
| 2020 Agosto | 29 | 23 | 52 |
| 2020 Julio | 74 | 14 | 88 |
| 2020 Junio | 59 | 15 | 74 |
| 2020 Mayo | 80 | 27 | 107 |
| 2020 Abril | 90 | 14 | 104 |
| 2020 Marzo | 69 | 23 | 92 |
| 2020 Febrero | 67 | 21 | 88 |
| 2020 Enero | 76 | 31 | 107 |
| 2019 Diciembre | 71 | 34 | 105 |
| 2019 Noviembre | 55 | 42 | 97 |
| 2019 Octubre | 59 | 34 | 93 |
| 2019 Septiembre | 50 | 54 | 104 |
| 2019 Agosto | 81 | 42 | 123 |
| 2019 Julio | 59 | 60 | 119 |
| 2019 Junio | 66 | 85 | 151 |
| 2019 Mayo | 63 | 100 | 163 |
| 2019 Abril | 45 | 88 | 133 |
| 2019 Marzo | 48 | 71 | 119 |
| 2019 Febrero | 45 | 46 | 91 |
| 2019 Enero | 42 | 50 | 92 |
| 2018 Diciembre | 50 | 46 | 96 |
| 2018 Noviembre | 61 | 64 | 125 |
| 2018 Octubre | 84 | 41 | 125 |
| 2018 Septiembre | 42 | 45 | 87 |
| 2018 Agosto | 2 | 0 | 2 |
| 2018 Mayo | 12 | 0 | 12 |
| 2018 Abril | 14 | 1 | 15 |
| 2018 Marzo | 17 | 1 | 18 |
| 2018 Febrero | 22 | 2 | 24 |
| 2018 Enero | 15 | 4 | 19 |
| 2017 Diciembre | 18 | 4 | 22 |
| 2017 Noviembre | 16 | 1 | 17 |
| 2017 Octubre | 19 | 3 | 22 |
| 2017 Septiembre | 34 | 3 | 37 |
| 2017 Agosto | 24 | 1 | 25 |
| 2017 Julio | 24 | 16 | 40 |
| 2017 Junio | 37 | 284 | 321 |
| 2017 Mayo | 25 | 259 | 284 |
| 2017 Abril | 31 | 201 | 232 |
| 2017 Marzo | 21 | 186 | 207 |
| 2017 Febrero | 9 | 193 | 202 |
| 2017 Enero | 16 | 99 | 115 |
| 2016 Diciembre | 86 | 69 | 155 |
| 2016 Noviembre | 133 | 89 | 222 |
| 2016 Octubre | 122 | 99 | 221 |
| 2016 Septiembre | 89 | 43 | 132 |
| 2016 Agosto | 94 | 49 | 143 |
| 2016 Julio | 57 | 51 | 108 |
| 2016 Mayo | 6 | 0 | 6 |
| 2016 Marzo | 3 | 0 | 3 |
| 2016 Febrero | 1 | 0 | 1 |
| 2016 Enero | 2 | 0 | 2 |
| 2015 Diciembre | 1 | 0 | 1 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Octubre | 8 | 0 | 8 |
| 2015 Septiembre | 6 | 63 | 69 |
| 2015 Agosto | 6 | 0 | 6 |
| 2015 Julio | 15 | 0 | 15 |
| 2015 Junio | 11 | 11 | 22 |
| 2015 Mayo | 13 | 0 | 13 |
| 2015 Abril | 17 | 26 | 43 |
| 2015 Marzo | 15 | 19 | 34 |
| 2015 Febrero | 4 | 19 | 23 |
| 2015 Enero | 14 | 2 | 16 |
| 2014 Diciembre | 28 | 1 | 29 |
| 2014 Noviembre | 26 | 1 | 27 |
| 2014 Octubre | 34 | 2 | 36 |
| 2014 Septiembre | 40 | 2 | 42 |
| 2014 Agosto | 38 | 2 | 40 |
| 2014 Julio | 44 | 1 | 45 |
| 2014 Junio | 93 | 4 | 97 |
| 2014 Mayo | 288 | 5 | 293 |
| 2014 Abril | 295 | 7 | 302 |
| 2014 Marzo | 321 | 28 | 349 |
| 2014 Febrero | 287 | 20 | 307 |
| 2014 Enero | 215 | 19 | 234 |
| 2013 Diciembre | 244 | 18 | 262 |
| 2013 Noviembre | 258 | 24 | 282 |
| 2013 Octubre | 242 | 33 | 275 |
| 2013 Septiembre | 152 | 22 | 174 |
| 2013 Agosto | 188 | 40 | 228 |
| 2013 Julio | 93 | 13 | 106 |
| 2013 Junio | 2 | 11 | 13 |
| 2013 Mayo | 2 | 9 | 11 |
| 2013 Abril | 7 | 4 | 11 |
| 2013 Marzo | 5 | 10 | 15 |
| 2013 Febrero | 26 | 4 | 30 |
| 2013 Enero | 21 | 2 | 23 |
| 2012 Diciembre | 16 | 4 | 20 |
| 2012 Noviembre | 4 | 3 | 7 |
| 2012 Agosto | 1 | 1 | 2 |
| 2001 Marzo | 6208 | 0 | 6208 |
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