Related Experiment Video

Updated: Jun 8, 2025

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

17.4K

Contemporary use of fibrinolytics in the management of pediatric empyema

Maria Grazia Sacco Casamassima1, Janelle R Noel-MacDonnell2, Tolulope A Oyetunji3

  • 1Department of Surgery, Children's Mercy Hospital, 2401, Gillham Road, Kansas City, MO, 64108, USA. msaccocasamassim@cmh.edu.

Pediatric Surgery International
|November 4, 2024
PubMed

Insights

Fibrinolysis is a common first-line treatment for pediatric empyema, showing effectiveness comparable to surgery. This less invasive approach is recommended for improved patient outcomes.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Medical Interventions

Background:

  • Pediatric empyema management has evolved, with increasing interest in less invasive therapeutic options.
  • Fibrinolysis, a treatment dissolving blood clots, is being evaluated for its role in managing pediatric empyema.

Purpose of the Study:

  • To investigate the current utilization and clinical effectiveness of fibrinolysis as a primary treatment for pediatric empyema.
  • To compare outcomes of fibrinolysis-based treatment with other standard approaches.

Main Methods:

  • A retrospective analysis of the Pediatric Health Information System (PHIS) database from 2018-2023.
  • Identification of pediatric patients diagnosed with empyema without fistula.
  • Comparison of outcomes (length of stay, need for subsequent surgery, complications, readmissions) between chest drainage (CD), chest drainage with fibrinolysis (CDF), and video-assisted thoracoscopic surgery/open decortication (VATS/OD) groups.

Main Results:

  • Fibrinolysis with chest drainage (CDF) was the most common first-line treatment (67.6%), followed by VATS/OD (20.7%) and CD alone (11.9%).
  • No significant differences in length of stay or 30-day readmission rates were observed between the groups after adjusting for covariates.
  • The VATS/OD group experienced a higher complication rate (11.7%) compared to CDF (4.1%) and CD (5.8%).

Conclusions:

  • Fibrinolysis is widely adopted as a first-line therapy and adjunct treatment for pediatric empyema.
  • The findings support the continued implementation of fibrinolysis as a less invasive and effective primary therapeutic option for pediatric empyema.
Abstract

Keywords:
AlteplaseEmpyemaFibrinolysisPHISPleural effusionVATS

More Related Videos

Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes03:53

Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes

Published on: April 19, 2024

480
An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug07:50

An In vitro System to Gauge the Thrombolytic Efficacy of Histotripsy and a Lytic Drug

Published on: June 4, 2021

2.7K

Related Concept Videos

Flail Chest-II01:26

Flail Chest-II

Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
160
Pneumonia IV: Management01:28

Pneumonia IV: Management

The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
300
Tonsillitis II: Management01:26

Tonsillitis II: Management

This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.
103
Acute Respiratory Failure-V01:29

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
123
Pleural Effusion II: Symptoms and Management01:28

Pleural Effusion II: Symptoms and Management

Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
154
Cystic Fibrosis: Management01:24

Cystic Fibrosis: Management

Cystic fibrosis (CF) is an autosomal recessive disorder that predominantly affects individuals of Northern European descent, occurring at a rate of 1 in 3500. It is caused by a genetic mutation in a gene on chromosome 7, most commonly the ΔF508 mutation, that codes for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. This results in thicker mucus secretions and obstruction pathologies in multiple organs, including the lungs and sinuses.
Sinus disease and chronic...
143