Transitioning paediatric empyema management: Comparative efficacy analysis of tPA and DNase versus surgical interventions
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View abstract on PubMed
Summary
This summary is machine-generated.Tissue plasminogen activator (tPA) and dornase alpha (DNase) combination therapy offers a safe and effective alternative for treating pediatric empyema. This approach resulted in lower intensive care unit admissions and treatment costs compared to surgery.
Area Of Science
- Pediatric Pulmonology
- Thoracic Surgery
- Pharmacological Interventions
Background
- Pediatric empyema presents a significant cause of childhood morbidity.
- Empyema also imposes a considerable financial burden on healthcare systems.
- Evaluating novel therapeutic strategies is crucial for improving patient outcomes and reducing healthcare costs.
Purpose Of The Study
- To compare the efficacy of combined tissue plasminogen activator (tPA) and dornase alpha (DNase) therapy with surgical interventions (VATS/thoracotomy) for pediatric empyema.
- To assess the impact of fibrinolytic therapy on hospitalisation duration, ICU admission rates, reintervention rates, treatment costs, and empyema relapse.
- To investigate the learning curve associated with tPA + DNase therapy in a pediatric cohort.
Main Methods
- Retrospective cohort study of 87 pediatric patients with empyema (January 2018 - December 2024).
- Patients were divided into surgical treatment (n=43) and tPA + DNase therapy (n=44) groups.
- Fibrinolytic group further analyzed by initial (n=22) and latest (n=22) periods to assess learning curve.
Main Results
- Hospitalisation duration was similar between groups (10 days vs. 11 days, p=0.086).
- The tPA + DNase group showed significantly lower ICU admission rates (13.6% vs. 34.8%, p=0.019) and treatment costs (€27,523 vs. €32,628, p=0.011).
- While the fibrinolytics group had a higher reintervention rate initially (36.0%), it significantly decreased in the latest period (9.1%, p=0.034), indicating a learning curve.
Conclusions
- Combined tPA and DNase therapy is a safe and effective treatment option for pediatric empyema.
- Fibrinolytic therapy offers advantages in reducing ICU admissions and healthcare costs.
- A learning curve exists for tPA + DNase therapy, with improved outcomes observed over time.
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