Fibrinolytics are not yet routinely used in addition to chest drainage in children with pleural empyema.
We assessed the number of children with empyema in which video assisted thoracoscopy (VATS) could be avoided in a centre where standard therapy is drainage using a chest drain with/without intrapleural fibrinolytics.
We included all children referred for chest drainage of a pleural effusion to RadboudUMC between January 2022 and April 2023. Children were referred in case of pneumonia with respiratory distress and suspected pleural effusion on the chest X-ray or an effusion size >20mm in the chest ultrasound, indicating the need for chest drainage or VATS. We analysed symptoms, test results, and treatment.
Thirty-three children aged 0-16 years were referred for treatment of pleural effusion. Most children presented with fever, cough, and dyspnoea (72%). Four children presented with abdominal pain (13%), which led to 2 appendectomies prior to referral. In 11(33%) children an invasive group A streptococcus was cultured from the pleural fluid. All patients were treated with antibiotics. One patient received VATS primarily. 27(84%) patients received a chest drain and four patients continued conservative treatment. 14(52%) of the 27 children with a chest drain were treated with intrapleural fibrinolytics (i.e. alteplase or urokinase) because of persistent pleural effusion on ultrasound despite chest drainage. No side effects were observed. Two patient received VATS secondary to chest drainage without receiving prior intrapleural fibrinolytics.
Intrapleural fibrinolytic treatment appeared safe and could avoid VATS in children with poor chest drainage and is therefore a useful minimal invasive treatment in children with pleural empyema.