Treatment of phase II empyema with intrapleural alteplase vs surgical debridement in children: A retrospective cohort study

Purpose Describe a treatment protocol with intrapleural alteplase for phase II empyema in children and compare its efficacy and development of complications with surgical debridement. Methods Retrospective cohort design of children with phase II empyema treated with surgical debridement or alteplase through thoracostomy. Clinical outcomes and postoperative complications were analyzed. Efficacy was evaluated by resolution of empyema and need for re- intervention. Results 38 patients were analyzed. Intrapleural alteplase presented less days of hospitalization (21.79 vs. 22.11 days), less blood transfusion requirement (36.84% vs. 42.11%) and less need (9 vs. 13 patients) and days of invasive mechanical ventilation (4.33 vs. 5.92 days), with no statistical difference (p = 0.68; p = 0.74; p = 0.68 respectively). Treatment failure was present in 4/19 patients treated with alteplase requiring further intervention compared to 6/19 patients treated with surgical debridement. Conclusions Intrapleural alteplase is as effective as surgical debridement for the treatment of phase II empyema for disease resolution and need for re-intervention. This study shows its safety and optimal clinical outcomes, minimal adverse events, less morbidity and clear clinical advantages due to its less invasive nature.