Long-term cardiopulmonary function in children treated for empyema: comparison of chest drain with fibrinolytics and video-assisted thoracoscopic surgery.

BACKGROUND

Complicated pneumonia in children can result in an empyema. The management options include chest drain insertion with fibrinolytic therapy (CDF) and video-assisted thoracoscopic surgery (VATS) with decortication. No studies have compared the long-term cardiopulmonary impact of treatment interventions using sensitive static and dynamic assessments of lung function.

AIM: To compare long-term cardiopulmonary function outcomes in children with empyema treated with CDF with those who underwent VATS using highly sensitive static and dynamic lung function measures.

METHODS

Children aged >8 years at the time of testing who were previously hospitalised with empyema and treated with either CDF or VATS were prospectively recruited. At one hospital, children were only treated by VATS, whereas CDF was used exclusively at the other site. As both sites belonged to the same network, all other aspects of treatment protocols were identical, and clinicians worked across both sites. Healthy controls were assessed as a comparison. Lung function testing included spirometry, lung volumes, multiple-breath washout (lung clearance index), oscillometry and cardiopulmonary exercise testing, all performed according to international standards.

RESULTS

51 children treated with CDF, 28 treated with VATS and 24 healthy controls participated in this study. Spirometry and lung clearance index were normal across all groups. However, oscillometry revealed significantly lower reactance in both treatment groups compared with controls (respiratory system reactance at 5 Hz: CDF -2.54 (0.98), VATS -4.08 (0.94), controls -0.24 (0.85)), with VATS showing greater impairment. The ratio of minute ventilation to oxygen uptake was highest in the VATS group compared with CDF and controls (39.7 (2.8), 36.8 (3.2) and 32.2 (2.7), respectively).

CONCLUSION

Long-term pulmonary outcomes following both CDF and VATS were generally reassuring. However, oscillometry and exercise testing revealed subtle differences in ventilatory strategies, with children post-VATS demonstrating mild residual impairment.