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Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial
Claudia Marhuenda1, Concepció Barceló2, Inmaculada Fuentes3
1Departments of Pediatric Surgery, claudia.marhuenda@ssib.es.
Insights
Drainage plus urokinase instillation is as effective as video-assisted thoracoscopic surgery for treating childhood parapneumonic empyema. This study found no significant differences in recovery times or treatment failures between the two methods.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Parapneumonic empyema (PPE) is a common complication of pediatric pneumonia.
- Optimal treatment strategies for pediatric PPE remain under investigation.
- Limited evidence exists comparing different first-line treatment options.
Purpose of the Study:
- To compare the efficacy of drainage plus urokinase instillation versus video-assisted thoracoscopic surgery (VATS) for childhood PPE.
- To evaluate key clinical outcomes including length of hospital stay and treatment success.
Main Methods:
- Prospective, randomized, multicenter clinical trial.
- Enrolled children (<15 years) with septated PPE.
- Randomized patients to urokinase instillation or VATS.
Main Results:
- No statistically significant differences observed between urokinase and VATS groups.
- Similar median postoperative stay (9 vs 10 days) and total hospital stay (13 vs 14 days).
- Comparable rates of requiring a second intervention (10% vs 15%).
Conclusions:
- Drainage plus urokinase is a viable and effective first-line treatment for septated PPE in children.
- Urokinase offers comparable outcomes to VATS in this pediatric population.
- This finding supports urokinase as an alternative to surgery for initial management.
Background And Objective:
Parapneumonic empyema (PPE) is a frequent complication of acute bacterial pneumonia in children. There is limited evidence regarding the optimal treatment of this condition. The aim of this study was to compare the efficacy of drainage plus urokinase versus video-assisted thoracoscopic surgery in the treatment of PPE in childhood.
Methods:
This prospective, randomized, multicenter clinical trial enrolled patients aged <15 years and hospitalized with septated PPE. Study patients were randomized to receive urokinase or thoracoscopy. The main outcome variable was the length of hospital stay after treatment. The secondary outcomes were total length of hospital stay, number of days with the chest drain, number of days with fever, and treatment failures. The trial was approved by the ethics committees of all the participating hospitals.
Results:
A total of 103 patients were randomized to treatment and analyzed; 53 were treated with thoracoscopy and 50 with urokinase. There were no differences in demographic characteristics or in the main baseline characteristics between the 2 groups. No statistically significant differences were found between thoracoscopy and urokinase in the median postoperative stay (10 vs 9 days), median hospital stay (14 vs 13 days), or days febrile after treatment (4 vs 6 days). A second intervention was required in 15% of children in the thoracoscopy group versus 10% in the urokinase group (P = .47).
Conclusions:
Drainage plus urokinase instillation is as effective as video-assisted thoracoscopic surgery as first-line treatment of septated PPE in children.
