Thoracoscopy Versus Fibrinolysis in Children With Empyema

Study Overview
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Brief Summary
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The null hypothesis is that patients receiving either thoracoscopy or fibrinolysis for empyema recover in the same amount of time. Therefore, we will test this by randomizing the next 40 patients who consent to the study to one treatment or the other.

Detailed Description
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This will be a single institution, prospective, randomized clinical trial involving patients who are found to have at least a single septation within a pleural effusion as diagnosed by ultrasound or computed tomography. Additionally, patients with a pleural effusion wherein a pleural tap reveals pus as defined by many (> 10,000/mm3 ) white blood cells or positive cultures will be considered. This is intended to be a definitive study. Power calculations based on the known 4.8 post intervention hospital days after VATS and the estimated 7 post intervention days after fibrinolysis with α = 0.05 and power of 0.8 show the need for 18 patients in each arm. We will intend to recruit 40. This sample size was constructed in consultation with Dr. Steve Simon, and the range of hospital stay in our retrospective experience was utilized. Therefore, this number should represent an adequate power in spite of the known varied level of illness. One group will undergo thoracoscopy to clean the pleural space and leave a chest tube postoperatively to drainage. The other group will undergo chest tube placement with subsequent infusion of fibrinolytics to dissolve the thick purulent material allowing drainage. Both groups will have the same antibiotic regimen with the same management algorithm.

Official Title
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Thoracoscopy Versus Fibrinolysis in Children With Empyema

Conditions
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Empyema

Intervention / Treatment
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* Procedure: Chest tube with tPA infusion for 3 days
* Procedure: VATS decortication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients less than 18 years of age requiring an intervention for empyema by one of the following: Septation or loculation seen on ultrasound or computed tomography Many white blood cells, bacteria present, or thick viscid purulence identified on pleural tap Exclusion Criteria: Immunodeficiency process Secondary diagnosis or condition that will keep them in the hospital beyond the empyema Existing contraindications to VATS or chest tube.

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>Video assisted thoracoscopic decortication | Procedure: VATS decortication<br>* thoracoscopic decortication<br>* Other names: pleural debridement;|
| Experimental: 2<br>Fibrinolysis through the chest tube | Procedure: Chest tube with tPA infusion for 3 days<br>* fibrinolysis through the chest tube<br>* Other names: tPA;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of hospitalization after intervention |  | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days where a maximum temperature was equal to or above 38 degrees C, days of tube drainage, doses of analgesia and days of oxygen requirement, hospital days after intervention, hospital charges after intervention and procedure charges |  | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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thoracoscopy, fibrinolysis, empyema, children