Prospective evaluation of lung function in children with parapneumonic empyema

Benedictis, Fernando Maria de; Carloni, Ines; Osimani, Patrizia; Cobellis, Giovanni; Martino, Ascanio; Lanza, Cecilia; Niccoli, Antonio; Azzari, Chiara; Skrami, Edlira; Gesuita, Rosaria

doi:10.1002/ppul.24204

Cited by 15 publications

(9 citation statements)

References 32 publications

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“…33 Since lung ultrasound offers several benefits over chest CT, such as wide availability, no need for sedation, low cost, and no radiation exposure, it has been recommended in children with complicated pneumonia. 34 All patients described by Gross et al 10 had a complete radiographic resolution in the follow-up, thus confirming the results of our 35 and other authors' 7-9 studies.…”

supporting

confidence: 90%

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

Benedictis

Carloni²

2019

Pediatric Pulmonology

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supporting

confidence: 90%

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

Benedictis

Carloni²

2019

Pediatric Pulmonology

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“…The proportion of cases of empyema caused by Streptococcus pneumoniae was relatively low compared to previous studies. [17][18][19] Lin et al 20 Pseudomonas aeruginosa was the third most common cause of empyema in this study. This is similar to the findings of a recent study conducted in Iran, which found a prevalence of Pseudomonas aeruginosa of 18.1% among 105 children with empyema.…”

Section: Fig 3 Study Flow Chartmentioning

confidence: 48%

Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018

Zhang¹,

Zhang²

2021

Turk J Pediatr

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Empyema, defined as the presence of pus in the pleural cavity, is a serious infectious condition with high morbidity and a 15-20% mortality. [1][2][3] The incidence of empyema in children has varied in recent decades. During 2006, an estimated total of 2,898 hospitalizations of children aged ≤18 years in the USA were due to empyema. The empyema-associated hospitalization rate was estimated at 3.7 per 100,000 children in 2006, compared to 2.2 per 100,000 in 1997. 4 Liese et al. 5 estimated the annual incidence of pediatric parapneumonic pleural effusion and pleural empyema hospitalizations in a nationwide surveillance study and found it to be 18.4 in 2010, which then decreased to 13.7 in 2013, and increased again to 17.3 in 2015 per million children. Generally, early and appropriate antibiotic therapy in children with pneumonia will avoid the development of empyema and its progression. Confirming the predominant pathogen of empyema is important to guide antimicrobial therapy. The bacteriology of pleural infection has changed over time. Recent data demonstrates that the distribution of pathogens causing empyema

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“…They have lower rates of needing rescue surgical therapy, and their long-term outcomes are almost always complete recovery with a near-zero rate of mortality. [25][26][27] In the current study, this difference was further amplified by the fact that we specifically excluded children with serious long-term comorbidities. Participants in the adult trial had a variety of comorbidities, and the mortality rate was 11% after 12 months of follow-up.…”

Section: Discussionmentioning

confidence: 93%

Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema

et al. 2020

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IMPORTANCE Clinical guidelines recommend that children with pleural empyema be treated with chest tube insertion and intrapleural fibrinolytics. The addition of dornase alfa (DNase) has been reported to improve outcomes in adults but remains unproven in children. OBJECTIVE To determine if intrapleural tissue plasminogen activator (tPA) and DNase is more effective than tPA and placebo at reducing hospital length of stay in children with pleural empyema. DESIGN, SETTING, AND PARTICIPANTS This multicenter, parallel-group, placebo-controlled, superiority randomized clinical trial included children diagnosed as having pleural empyema requiring drainage aged 6 months to 18 years treated at 6 tertiary Canadian children's hospitals. A total of 379 children were assessed for eligibility; 281 were excluded and 98 were randomized. One child was excluded after randomization for not meeting the inclusion criteria. Data were collected from March 4, 2013, to December 13, 2017. INTERVENTIONS Participants underwent chest tube insertion and 3 daily administrations of intrapleural tPA, 4 mg, followed by DNase, 5 mg (intervention group), or 5 mL of normal saline (placebo; control group). Participants, families, clinical staff, and members of the study team were blinded to allocation. MAIN OUTCOMES AND MEASURES The primary outcome was hospital length of stay from chest tube insertion to discharge. Secondary outcomes included time to meeting discharge criteria, time to chest tube removal, mean fever duration, additional pleural drainage procedures, hospital readmissions, and total health care cost. RESULTS Of the 97 analyzed children with pleural empyema, 52 (54%) were male, and the mean (SD) age was 5.1 (3.6) years. A total of 49 children were randomized to tPA and DNase and 48 were randomized to tPA and placebo. Treatment with tPA and DNase was not associated with decreased hospital length of stay compared with tPA and placebo (mean [SD] length of stay, 9.0 [4.9] vs 9.1 [5.3] days; mean difference, −0.1 days; 95% CI, −2.0 to 2.1; P = .96). Similarly, no significant differences were observed for any of the secondary outcomes. Of the 14 adverse events in the tPA and DNase group, 6 (43%) were serious; of the 21 adverse events in the tPA and placebo group, 8 (38%) were serious. There were no deaths. CONCLUSIONS AND RELEVANCE The addition of DNase to intrapleural tPA for children with pleural empyema had no effect on hospital length of stay or other outcomes compared with tPA with placebo. Clinical practice guidelines should continue to support the use of chest tube insertion and intrapleural fibrinolytics alone as first-line treatment for pediatric empyema. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01717742

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Prospective evaluation of lung function in children with parapneumonic empyema

Cited by 15 publications

References 32 publications

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018

Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema

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