INTRODUCTION: We previously reported a prospective, randomized trial comparing video-assisted thoracoscopic decortication (VATS) to fibrinolysis for the treatment of empyema. In that study no advantages to VATS were identified, although VATS resulted in significantly higher hospital charges. We subsequently implemented the algorithm from the trial utilizing primary fibrinolytic therapy in all children diagnosed with empyema. In this study, we reviewed our experience to examine the clinical efficacy of this protocol. METHODS: After IRB approval, we conducted a retrospective review of all children diagnosed with empyema as all were treated with the fibrinolysis protocol utilized in the prospective trial since the completion of the trial. RESULTS: In 102 consecutive patients treated with fibrinolysis, 16 patients (15.7%) required subsequent VATS. No patients were treated with initial VATS. No major side effects were seen from fibrinolytic therapy. Mean operative time for VATS after fibrinolysis was 62 minutes. The length of stay after VATS was 5.9 days. CONCLUSIONS: The results of an evidence-based protocol using fibrinolysis to treat empyema have replicated the results of the trial that led to the implementation of the protocol. The pediatric empyema population can be successfully treated without an operation in the majority of cases.
INTRODUCTION: We previously reported a prospective, randomized trial comparing video-assisted thoracoscopic decortication (VATS) to fibrinolysis for the treatment of empyema. In that study no advantages to VATS were identified, although VATS resulted in significantly higher hospital charges. We subsequently implemented the algorithm from the trial utilizing primary fibrinolytic therapy in all children diagnosed with empyema. In this study, we reviewed our experience to examine the clinical efficacy of this protocol. METHODS: After IRB approval, we conducted a retrospective review of all children diagnosed with empyema as all were treated with the fibrinolysis protocol utilized in the prospective trial since the completion of the trial. RESULTS: In 102 consecutive patients treated with fibrinolysis, 16 patients (15.7%) required subsequent VATS. No patients were treated with initial VATS. No major side effects were seen from fibrinolytic therapy. Mean operative time for VATS after fibrinolysis was 62 minutes. The length of stay after VATS was 5.9 days. CONCLUSIONS: The results of an evidence-based protocol using fibrinolysis to treat empyema have replicated the results of the trial that led to the implementation of the protocol. The pediatric empyema population can be successfully treated without an operation in the majority of cases.
Authors: Marijke Proesmans; Brenda Gijsens; Patricia Van de Wijdeven; Herbert De Caluwe; Jan Verhaegen; Katrien Lagrou; Ellen Van Even; Francois Vermeulen; Kris De Boeck Journal: Eur J Pediatr Date: 2014-05-17 Impact factor: 3.183
Authors: Charles A James; P Spencer Lewis; Mary B Moore; Kevin Wong; Emily K Rader; Paula K Roberson; Nancy A Ghaleb; Hanna K Jensen; Amir H Pezeshkmehr; Michael H Stroud; Daniel J Ashton Journal: Pediatr Radiol Date: 2022-04-22