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Pediatrics |

Lung Necrosectomy in Pediatric Patients With Necrotizing Pneumonia

Francina Bolaños, MD; Patricio Santillán Doherty, MD; Luis Marcelo Argote Greene, MD; Maria Elena Aguilar, MD; Santibañez Sandoval José Alfredo, MD; Maria del Socorro Ortiz Gea, MD
Author and Funding Information

Instituto Nacional de la Nutricion y Ciencias Medicas Salvador Zubira, Mexico Distrito Federal, Mexico


Chest. 2014;145(3_MeetingAbstracts):454A. doi:10.1378/chest.1729274
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Abstract

SESSION TITLE: Pediatrics

SESSION TYPE: Slide Presentations

PRESENTED ON: Sunday, March 23, 2014 at 12:15 PM - 01:15 PM

PURPOSE: Necrotizing Pneumonia is a rare complication of bacterial pulmonary infection in children that has become more prevalent since the introduction of antibiotics. The treatment with appropriate antibiotics resolve the clinical course of necrotizing pneumonia in children, nevertheless, a small number of patients might need surgical treatment. The objective of this study is to present the results of the conservative surgical approach: Lung Necrosectomy, in children with necrotizing pneumonia.

METHODS: From January 2006 to July 2011 the medical charts of children admitted with pneumonia were reviewed. The diagnosis of necrotizing pneumonia was based on the physical examination (fever, signs of consolidation during thoracic percussion), laboratory data (leokocytosis, positive sputum and blood cultures) and signs on the contrasted computer tomography (pulmonary consolidation, intraparenchymal bullae and hypovascularization).

RESULTS: Twenty two children fulfilled the diagnosis. Sixteen (72.7%) were girls and 6 (27.7%) were boys. The mean age was 30.5 months (10-48 months). All the patients had productive cough, fever, dyspnea, consolidated areas on the chest x-rays and the contrasted CT scan confirmed the diagnosis of lung necrosis (pulmonary consolidation, intraparenchymal bullae and hypoperfusion). The surgical procedures performed were: Lung necrosectomy 15 (68.18%); lobectomy 4 (18.8%); Non anatomical segmentectomy 2 (9.09%); lobectomy + lung necrosectomy 1 (4.5%), and non anatomical segmentectomy + lung necrosectomy 1 (4.5%) patient. The postoperative course was uneventful in 21 (94.5%) patients, which were weaned off from mechanical ventilation using the fast track protocol. Chest tubes were in place during 5.7 days. They were discharged off the Hospital 6.3 days after the surgical procedure and after completing the antibiotic treatment. One patient died because of sepsis.

CONCLUSIONS: Lung Necrosectomy is a conservative, effective surgical treatment, that solves lung necrotizing infection avoiding a more extensive healthy lung parenchyma resection.

CLINICAL IMPLICATIONS: In our institution, we have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia: Lung Necrosectomy, circumscribed to the necrotic tissue, that means, we perform curettage or resection directly over the necrotic tissue, avoiding segmentectomy or lobectomy in order to leave as much healthy or recoverable non necrotic lung tissue as possible.

DISCLOSURE: The following authors have nothing to disclose: Francina Bolaños, Patricio Santillán Doherty, Luis Marcelo Argote Greene, Maria Elena Aguilar, Santibañez Sandoval José alfredo, Maria del Socorro Ortiz Gea

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