Lung necrosectomy in pediatric patients with necrotizing pneumonia
Introduction Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or...
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Veröffentlicht in: | General thoracic and cardiovascular surgery 2018-03, Vol.66 (3), p.155-160 |
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creator | Bolaños-Morales, Francina V. Gómez-Portugal, Emmanuel Peña Aguilar-Mena, María E. Santillán-Doherty, Patricio J. Sotres-Vega, Avelina Santibáñez-Salgado, J. Alfredo |
description | Introduction
Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.
Methods
Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.
Results
Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.
Conclusions
Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma. |
doi_str_mv | 10.1007/s11748-017-0862-1 |
format | Article |
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Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.
Methods
Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.
Results
Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.
Conclusions
Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.</description><identifier>ISSN: 1863-6705</identifier><identifier>EISSN: 1863-6713</identifier><identifier>DOI: 10.1007/s11748-017-0862-1</identifier><identifier>PMID: 29159658</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Antibiotics ; Cardiac Surgery ; Cardiology ; Chest tubes ; Child ; Child, Preschool ; Debridement - methods ; Dyspnea ; Female ; Fistula ; Hospitals ; Humans ; Infant ; Lung - surgery ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Necrosis ; Original Article ; Ostomy ; Patients ; Pediatrics ; Pneumonectomy - methods ; Pneumonia ; Pneumonia, Necrotizing - surgery ; Radiography ; Retrospective Studies ; Sepsis ; Streptococcus infections ; Surgical Oncology ; Thoracic Surgery ; Treatment Outcome ; Ventilation ; Ventilators</subject><ispartof>General thoracic and cardiovascular surgery, 2018-03, Vol.66 (3), p.155-160</ispartof><rights>The Japanese Association for Thoracic Surgery 2017</rights><rights>The Japanese Association for Thoracic Surgery 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-4951306cef71b1d3579de6a88fbe80fc4510977215e8f5648e89839d14bdb7693</citedby><cites>FETCH-LOGICAL-c396t-4951306cef71b1d3579de6a88fbe80fc4510977215e8f5648e89839d14bdb7693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11748-017-0862-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918739048?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33531,33744,33745,41488,42557,43659,43805,51319,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29159658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bolaños-Morales, Francina V.</creatorcontrib><creatorcontrib>Gómez-Portugal, Emmanuel Peña</creatorcontrib><creatorcontrib>Aguilar-Mena, María E.</creatorcontrib><creatorcontrib>Santillán-Doherty, Patricio J.</creatorcontrib><creatorcontrib>Sotres-Vega, Avelina</creatorcontrib><creatorcontrib>Santibáñez-Salgado, J. Alfredo</creatorcontrib><title>Lung necrosectomy in pediatric patients with necrotizing pneumonia</title><title>General thoracic and cardiovascular surgery</title><addtitle>Gen Thorac Cardiovasc Surg</addtitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><description>Introduction
Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.
Methods
Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.
Results
Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.
Conclusions
Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.</description><subject>Antibiotics</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Chest tubes</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Debridement - methods</subject><subject>Dyspnea</subject><subject>Female</subject><subject>Fistula</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Lung - surgery</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Necrosis</subject><subject>Original Article</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumonectomy - methods</subject><subject>Pneumonia</subject><subject>Pneumonia, Necrotizing - surgery</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Streptococcus infections</subject><subject>Surgical Oncology</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>1863-6705</issn><issn>1863-6713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kMtKxDAUhoMozjj6AG6k4MZNNadpbksdvMGAG12HXk7HDNO0Ni0yPr0ZOo4guEog3__nnI-Qc6DXQKm88QAyVTEFGVMlkhgOyBSUYLGQwA73d8on5MT7FaVcKODHZJJo4FpwNSV3i8EtI4dF13gs-qbeRNZFLZY26ztbRG3WW3S9jz5t_z5yvf2yIdM6HOrG2eyUHFXZ2uPZ7pyRt4f71_lTvHh5fJ7fLuKCadHHqebAqCiwkpBDybjUJYpMqSpHRasi5UC1lAlwVBUXqUKlFdMlpHmZS6HZjFyNvW3XfAzoe1NbX-B6nTlsBm9AC6E1KM0CevkHXTVD58J0JqyuJNM0VYGCkdou7zusTNvZOus2BqjZCjajYBMEm61gAyFzsWse8hrLfeLHaACSEfDhyS2x-_36_9Zvsq6E_g</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Bolaños-Morales, Francina V.</creator><creator>Gómez-Portugal, Emmanuel Peña</creator><creator>Aguilar-Mena, María E.</creator><creator>Santillán-Doherty, Patricio J.</creator><creator>Sotres-Vega, Avelina</creator><creator>Santibáñez-Salgado, J. Alfredo</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20180301</creationdate><title>Lung necrosectomy in pediatric patients with necrotizing pneumonia</title><author>Bolaños-Morales, Francina V. ; Gómez-Portugal, Emmanuel Peña ; Aguilar-Mena, María E. ; Santillán-Doherty, Patricio J. ; Sotres-Vega, Avelina ; Santibáñez-Salgado, J. Alfredo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-4951306cef71b1d3579de6a88fbe80fc4510977215e8f5648e89839d14bdb7693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Antibiotics</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Chest tubes</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Debridement - methods</topic><topic>Dyspnea</topic><topic>Female</topic><topic>Fistula</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infant</topic><topic>Lung - surgery</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Necrosis</topic><topic>Original Article</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumonectomy - methods</topic><topic>Pneumonia</topic><topic>Pneumonia, Necrotizing - surgery</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Sepsis</topic><topic>Streptococcus infections</topic><topic>Surgical Oncology</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bolaños-Morales, Francina V.</creatorcontrib><creatorcontrib>Gómez-Portugal, Emmanuel Peña</creatorcontrib><creatorcontrib>Aguilar-Mena, María E.</creatorcontrib><creatorcontrib>Santillán-Doherty, Patricio J.</creatorcontrib><creatorcontrib>Sotres-Vega, Avelina</creatorcontrib><creatorcontrib>Santibáñez-Salgado, J. Alfredo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>General thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bolaños-Morales, Francina V.</au><au>Gómez-Portugal, Emmanuel Peña</au><au>Aguilar-Mena, María E.</au><au>Santillán-Doherty, Patricio J.</au><au>Sotres-Vega, Avelina</au><au>Santibáñez-Salgado, J. Alfredo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lung necrosectomy in pediatric patients with necrotizing pneumonia</atitle><jtitle>General thoracic and cardiovascular surgery</jtitle><stitle>Gen Thorac Cardiovasc Surg</stitle><addtitle>Gen Thorac Cardiovasc Surg</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>66</volume><issue>3</issue><spage>155</spage><epage>160</epage><pages>155-160</pages><issn>1863-6705</issn><eissn>1863-6713</eissn><abstract>Introduction
Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.
Methods
Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.
Results
Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.
Conclusions
Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>29159658</pmid><doi>10.1007/s11748-017-0862-1</doi><tpages>6</tpages></addata></record> |
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subjects | Antibiotics Cardiac Surgery Cardiology Chest tubes Child Child, Preschool Debridement - methods Dyspnea Female Fistula Hospitals Humans Infant Lung - surgery Male Medical imaging Medicine Medicine & Public Health Necrosis Original Article Ostomy Patients Pediatrics Pneumonectomy - methods Pneumonia Pneumonia, Necrotizing - surgery Radiography Retrospective Studies Sepsis Streptococcus infections Surgical Oncology Thoracic Surgery Treatment Outcome Ventilation Ventilators |
title | Lung necrosectomy in pediatric patients with necrotizing pneumonia |
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