Related Experiment Video
Updated: Jan 11, 2026
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Transitioning paediatric empyema management: Comparative efficacy analysis of tPA and DNase versus surgical
Henri Haapanen1, Antti Huuskonen1, Tea Nieminen2
1New Children's Hospital, Surgery and Anaesthesia Unit, Cardiothoracic Surgery, Helsinki, Finland.
Insights
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.
Introduction:
Empyema significantly impacts paediatric morbidity and imposes a financial burden on healthcare systems. This study evaluates the efficacy of tissue plasminogen activator (tPA) and dornase alpha (DNase) combination in fibrinolytic therapy compared with surgical interventions (VATS/thoracotomy) in children with empyema.
Materials And Methods:
A retrospective cohort consisted of 87 consecutive patients from January 2018 to December 2024, of whom 43 underwent surgical treatment and 44 received tPA + DNase therapy. The fibrinolytics group was divided into two subgroups to assess the learning curve: initial period (n = 22) and latest period (n = 22). The primary outcome was the hospitalisation duration. The secondary outcome measures included intensive care unit (ICU) admission rate, reintervention rate, costs of treatment, and empyema relapse within 30 days.
Results:
The median age was 3.9 years (range 0.7-17.3). The median duration of hospitalisation was 11 [9-14] days in VATS/thoracotomy group and 10 [7-13] days in fibrinolytics group (p = 0.086). The ICU admission rate was significantly lower in the fibrinolytics group (34.8 % vs. 13.6 %, p = 0.019), as were the costs of treatment (€32,628 [€25,386 - €44,504] vs €27,523 [€19,264 - €34,662], p = 0.011). Two empyema relapses were observed in each group. No readmissions occurred. The fibrinolytics group demonstrated higher reintervention rate compared to VATS/thoracotomy group (22.7 % vs. 7.0 %, p = 0.038) but significantly decreased in the latest period compared to the initial period (9.1 % vs. 36.0 %, p = 0.034), indicating a clear learning curve.
Conclusion:
tPA + DNase therapy is a safe and effective management option for paediatric empyema.
Related Concept Videos
01:26Tonsillitis II: Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...