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Position paper on video-assisted thoracoscopic surgery as treatment of pediatric empyema

Evan R Kokoska1, Mike K Chen,

  • 1Cincinnati Children's Hospital Medical Center, Peyton Manning Children's Hospital, Indianapolis, IN 46260, USA.

Journal of Pediatric Surgery
|January 23, 2009
PubMed

Insights

This paper reviews pediatric empyema treatments, highlighting limited evidence for an ideal strategy. It suggests a therapeutic algorithm for managing pediatric empyema based on current evidence.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Pediatric empyema management lacks a universally agreed-upon ideal strategy.
  • Treatment options vary based on the stage of empyema, from simple effusions to fibrotic disease.

Purpose of the Study:

  • To discuss controversies in pediatric empyema management.
  • To summarize evidence-based treatment options.
  • To propose a therapeutic algorithm for pediatric empyema.

Main Methods:

  • Review of existing literature on pediatric empyema treatments.
  • Evidence-based summary of various therapeutic modalities.
  • Development of a treatment algorithm by the New Technology Committee of the American Pediatric Surgery Association.

Main Results:

  • Early/simple pediatric empyema may be treated with antibiotics alone or with drainage.
  • Fibrinopurulent empyema often requires chest tube with fibrinolytics or video-assisted thoracoscopic surgery (VATS) with decortication.
  • Late/fibrotic empyema typically involves decortication, either thoracoscopically or via minithoracotomy.

Conclusions:

  • A clear evidence-based algorithm is needed for pediatric empyema care.
  • Treatment selection should be guided by the stage and characteristics of the empyema.
  • This paper provides a framework for decision-making in pediatric empyema management.

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