Interest of physiotherapy care in management purulent pleurisy of children

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Background: Children purulent pleurisy (PP) is the presence of pus in the pleural cavity. In Tunisia, the incidence of CPP has increased by 20-25% the last five years. Methods: This is a retrospective study of child’s PP admitted between 2010 and 2024 at the Pediatric Intensive Care Unit of the Children's Hospital in Tunisia. We have analyzed etiological, diagnostic and therapeutic features and the interest of physiotherapy management in rehabilitation. Physiotherapy consists of the adoption of the prone position, oxygen therapy, nasal washing, oral and nasopharyngeal aspiration, aerosol therapy, bronchoalveolar washing. Results: The study included 24 patients, 15 male and 9 females, aged from 19 days to 14 years. Cough was reported in 8 patients (33%). Dyspnea (82%), polypnea (63%) and decrease of SPO2 (42%) are the main symptoms. Purulent effusion was observed on the right side (71%). Staphylococcal (42%) and pneumococcal (17%) infections were the main etiologies. Fourteen patients (63%) had C-Protein reaction CRP greater than 100mg/ l among them 21% had CRP greater than 300mg/l indicating significant infection. Therapeutic management consisted of the evacuation of pleural fluid by drainage (63%), or pleural puncture (34%) associated with antibiotic therapy. After this, physiotherapy care was performed in all children. The evolution was favorable in 83%. Only 4 children died after the occurrence of hemodynamic disorders complicating sepsis. Conclusion: PP is an urgent reason for hospitalization of children. Physiotherapy care associated to antibiotic therapy and appropriate management of the respiratory failure upon admission may avoid the need for intubation and mechanical ventilation.

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