Thoracoscopy Versus Fibrinolysis in Children With Empyema

Phase 2

Completed

• Conditions: Empyema
• Interventions: Procedure: VATS decortication; Procedure: Chest tube with tPA infusion for 3 days

• Registration Number: NCT00323531
• Lead Sponsor: Children's Mercy Hospital Kansas City

Brief Summary

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

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.

Study Timeline

• Study Start: 2006-03
• Study First Submitted: 2006-05-08
• Study First Submitted QC: 2006-05-08
• Study First Posted: 2006-05-09
• Primary Completion: 2007-10
• Study Completion: 2007-10
• Status Verified: 2008-05
• Last Update Submitted: 2008-05-06
• Last Update Posted: 2008-05-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 36

Inclusion Criteria

• Patients less than 18 years of age requiring an intervention for empyema by one of the following:

  1. Septation or loculation seen on ultrasound or computed tomography
  2. Many white blood cells, bacteria present, or thick viscid purulence identified on pleural tap

Exclusion Criteria

1. Immunodeficiency process
2. Secondary diagnosis or condition that will keep them in the hospital beyond the empyema
3. Existing contraindications to VATS or chest tube.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
1	VATS decortication	Video assisted thoracoscopic decortication
2	Chest tube with tPA infusion for 3 days	Fibrinolysis through the chest tube

Primary Outcome Measures

Name	Time	Method
Length of hospitalization after intervention	1 month

Secondary Outcome Measures

Name	Time	Method
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

Trial Locations

Locations (1)

Children's Mercy Hospital; 🇺🇸 Kansas City, Missouri, United States