Resumo

CABRERA REYES, Javier et al. Guide of clinical practice on parapneumonic pleural efussion and pleural empyema. Rev Cubana Pediatr [online]. 2020, vol.92, n.3  Epub 01-Set-2020. ISSN 1561-3119.

The accumulation of purulent fluids or the presence of bacteria in the Gram´s stain in the pleural liquid is defined as empyema. It can develop in the 2 to 12% of children with pneumonia, generally the bacterial one. It evolves in three phases: exudative, fibrinopurulent and organized. The clinical picture is a consequence of respiratory manifestations with persistent fever and general discomfort. The radiology studies are important for the diagnosis and the pleural ultrasound is the preferred imaging modality because it confirms the presence and volume of the pleural fluid, as well as the existence of septa. The treatment is based in the use of antibiotic therapy and the drainage through a pleurostomy; if there is presence of septa, slough or the biochemical study of the pleural liquid informs of pH/7, glucose /2.2 mmol/L, LDH / 1000 UI, so it is started the use of intrapleural streptokinase. The surgical treatment is indicated if there is a clinical and radiological worsening after finishing the use of fibrinolytics, persistence of sepsis associated to pleural collection in spite of the drainage, fibrin shell that hampers pulmonar reexpanding; and bronchopleural fistula with pneumothorax.

Palavras-chave : empyema; parapneumonic pleural efussion; fibrinolytic therapy; surgical treatment.

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