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Intrapleural Fibrinolytic Therapy for Pediatric Empyema: What Is the Proper Regimen?

West Erin1, Schermerhorn Sophia1, Claire Allison2

  • 1Department of Pediatric Surgery, Rady Children's Hospital, San Diego, California.

The Journal of Surgical Research
|May 12, 2026
PubMed

Insights

Intrapleural fibrinolytic therapy (IFT) using tissue plasminogen activator (tPA) is effective for pediatric empyema. Three days of consecutive IFT treatment resulted in the shortest chest tube duration, indicating an optimal regimen.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Pediatric Critical Care

Background:

  • Intrapleural fibrinolytic therapy (IFT) with tissue plasminogen activator (tPA) is a primary treatment for pediatric empyema.
  • Treatment protocols for IFT vary significantly in duration and dosing frequency.
  • Optimizing IFT regimens is crucial for improving patient outcomes.

Purpose of the Study:

  • To review patient outcomes associated with IFT for pediatric empyema.
  • To identify the most effective treatment regimen for IFT in pediatric empyema management.
  • To analyze the impact of IFT duration and timing on clinical outcomes.

Main Methods:

  • Retrospective review of patients with empyema treated with chest tube (CT) placement and tPA installation (2012-2024).
  • Exclusion of patients with pleural collections from chylothorax, malignancy, or cardiac surgery.
  • Grouping patients based on the duration and timing of fibrinolytic therapy; primary outcome: CT duration.

Main Results:

  • 106 patients (113 CTs) received IFT; 38.9% received <3 days, 38.9% received 3 days, and 22% received >3 days of tPA.
  • Patients receiving 3 days of tPA had the shortest CT duration (6 days) (P=0.013).
  • Consecutive tPA administration was associated with shorter CT duration (6 days) compared to selective administration (9.5 days) (P=0.002).

Conclusions:

  • Intrapleural fibrinolytic therapy is a safe and effective treatment for pediatric empyema.
  • A 3-day course of consecutive intrapleural fibrinolytic therapy is associated with the shortest chest tube duration.
  • Optimized IFT regimens can potentially reduce treatment duration and improve outcomes in pediatric empyema.
Abstract

Keywords:
AlteplaseChest tubeEmpyemaIntrapleural fibrinolytic therapytPA

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