Local treatment of empyema in children: a systematic review of randomized controlled trials.
The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS.


CONCLUSIONS
There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.
Krenke
Katarzyna
K
Department of Paediatric Pneumonology and Allergy, The Medical University of Warsaw, Poland. kkrenke@amwaw.edu.pl
Peradzyńska
Joanna
J
Lange
Joanna
J
Ruszczyński
Marek
M
Kulus
Marek
M
Szajewska
Hania
H
D002648:Child; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000601:surgery; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007322:Instillation, Drug; D007902:Length of Stay; D010996:Pleural Effusion / Q000188:drug therapy* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator