Pediatric Thoracic Empyema-Outcomes of Intrapleural Thrombolytics: Ten Years of Experience

Area of Science:

• Pediatric Pulmonology
• Thoracic Surgery
• Infectious Diseases

Background:

• Pediatric thoracic empyema is increasingly common, with evolving management strategies.
• Current treatment consensus is not well-established.
• Intrapleural thrombolytics are being explored as a primary intervention.

Purpose of the Study:

• To evaluate the efficacy of intrapleural thrombolytics as a first-line treatment for pediatric thoracic empyema.
• To assess outcomes in children treated with tissue plasminogen activator following failed simple thoracostomy.
• To analyze a 10-year single-center experience with this management approach.

Main Methods:

• An observational prospective study was conducted.
• Included were 95 pediatric patients (1 day to 18 years) with parapneumonic effusion treated with intrapleural thrombolytics.
• Data collected from January 2008 to December 2018.

Main Results:

• An average of 2.1 doses of thrombolytics were administered.
• Mean drainage volume was 1050 mL, with a mean hospitalization of 7.3 days.
• Complete thoracic re-expansion was achieved in 98.9% of patients.

Conclusions:

• Intrapleural thrombolytics demonstrate excellent outcomes in complicated pediatric thoracic empyema.
• This treatment should be considered, especially in resource-limited settings.
• Tissue plasminogen activator is a viable first-line option after initial drainage failure.