Management of Parapneumonic Effusions:Current Practice and Controversies

The incidence of complicated parapneumonic effusions in children has been increasing over the past decade despite the increasing use of protein-conjugate vaccines against Streptococcus pneumoniae, the most common cause of complicated pneumonia in children in the developed world. Despite the fact that this condition is increasingly common in hospitalized children, the management of this condition remains controversial, in large part due to the small number of prospective, controlled trials evaluating therapies. This review will highlight the epidemiology, diagnosis and management of complicated parapneumonic effusions. The role for intrapleural fibrinolytic therapy and early videoassisted thorascopic surgery in the management of this condition will be emphasized as will the questions that need to be answered with future inquiry.