Fibrinolysis as a Treatment for Empyema

The treatment of empyema (placement of a chest tube with instillation of a fibrinolytic medication to "break up" the infection vs. surgery to remove the infected material) has been long debated, as treatment failure can result in prolonged infection.

In 2009, we published a prospective, randomized trial in the Journal of Pediatric Surgery comparing these two treatment options. We found that three patients (16.6%) who underwent fibrinolysis (chest tube placement with medication instillation) went on to require surgery for treatment failure. Two children required ventilator support for clinical deterioration after surgery, while no child who underwent fibrinolysis clinically worsened.

These findings allowed us to further refine a protocol for the treatment of empyema in children, which involves using fibrinolysis as a first-line therapy. This protocol is still in use today and has been retrospectively reviewed and demonstrated to be safe and effective. In addition, we have partnered with our Infectious Diseases colleagues to determine how long a child should be on antibiotics for empyema.

Our latest research highlights how raising the threshold for surgical intervention and utilizing further nonoperative measures can avoid an operation in most children without increasing in-hospital length of stay.

Read the publication on fibrinolysis as a treatment for empyema.