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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las neumon&#237;as son una de las causas m&#225;s frecuentes de derrame pleural en los ni&#241;os&#46; El 0&#44;6-2 &#37; de las neumon&#237;as se complican con empiema y aproximadamente el 40&#37; de las neumon&#237;as que precisan hospitalizaci&#243;n en ni&#241;os presentan derrame pleural&#46; En los &#250;ltimos a&#241;os&#44; <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> es el germen aislado con mayor frecuencia&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tratamiento se basa en el empleo adecuado y precoz de antibi&#243;ticos&#44; t&#233;cnicas de imagen&#44; toracocentesis&#44; drenaje pleural&#44; fibrinol&#237;ticos&#44; toracoscopia y toracotom&#237;a&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La colocaci&#243;n de un drenaje pleural est&#225; indicada de forma precoz en las siguientes situaciones&#58; presencia de pus en el espacio pleural&#44; tinci&#243;n de Gram positiva del l&#237;quido pleural&#44; glucosa del l&#237;quido pleural inferior a 50 mg&#47;dl&#44; pH del l&#237;quido pleural inferior a 7&#44; presencia de septos o tabiques en el l&#237;quido pleural en la ecograf&#237;a&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La instilaci&#243;n local de fibrinol&#237;ticos puede disminuir la necesidad de tratamiento quir&#250;rgico&#44; con una eficacia entre el 38 y el 100 &#37;&#44; seg&#250;n lo avanzado del estadio del derrame&#46; El desbridamiento por toracoscopia es &#250;til en fase fibrinopurulenta con tabicaciones y adherencias&#44; con resultados favorables seg&#250;n la precocidad de su realizaci&#243;n&#44; entre el 30-100 &#37;</p>"
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Vol. 54. Núm. 3.
Páginas 272-282 (marzo 2001)
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Vol. 54. Núm. 3.
Páginas 272-282 (marzo 2001)
Acceso a texto completo
Tratamiento de los derrames pleurales paraneumónicos
Management of parapneumonic pleural effusions
Visitas
34177
O. Asensio de la Cruza, J. Blanco Gonzálezb, A. Moreno Galdóc,
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
, 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
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
Este artículo ha recibido
Información del artículo

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, Streptococcus pneumoniae es el germen aislado con mayor frecuencia.

El tratamiento se basa en el empleo adecuado y precoz de antibióticos, técnicas de imagen, toracocentesis, drenaje pleural, fibrinolíticos, toracoscopia y toracotomía.

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.

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 %

Palabras clave:
Neumonías
Derrame pleural paraneumónico
Empiema
Drenaje pleural
Fibrinolíticos
Toracoscopia
Niños

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.

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

Key words:
Pneumonia
Parapneumonic pleural effusion
Empyema
Pleural drainage
Fibrinolytics
Thoracoscopy
Children
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Miembros del grupo de trabajo: 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).

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