Journal of paediatrics and child health · 2026
Management Strategies for Paediatric Pleural Empyema: A Systematic Review.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Shahar Atheer I, Alghamdi Maryam Mohammed, Athwani Zainab Ahmed, Ayoub Lama Hassan, Mutahar Afraa Hashim, Alenazi Ayed Mohammed, Alanazi Alnashmi S
Аннотация
AIM: To examine and compare management strategies for paediatric pleural empyema with respect to efficacy, safety, length of hospital stays, complications and long-term outcomes.
METHODS: Database searches across PubMed, Web of Science, Cochrane Library and ScienceDirect (January 2005-May 2025) were conducted following PRISMA guidelines. After exclusions, 22 studies (RCTs and observational) were included. Quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Because studies defined success inconsistently, effectiveness was also expressed as single-procedure success: resolution without a further drainage procedure. Other outcomes included reintervention, hospital stay, complications and mortality.
RESULTS: Included were 18 cohort studies and 4 RCTs (3667 patients; empyema stages 1-3). Evaluated approaches included video-assisted thoracic surgery (VATS), intrapleural fibrinolysis, chest tube drainage and thoracotomy. Study-reported success ranged from 90%-96% with VATS and 70%-95% with fibrinolysis; expressed as single-procedure success, these fell to 67%-100% and 63%-98%, respectively, against 47% for drainage alone. Chest tube duration was often shorter after VATS, although the drain serves a different purpose in each pathway and is not a measure of efficacy. Overall complication rates were low; bronchopleural fistula was reported by only three studies.
CONCLUSIONS: Both VATS and intrapleural fibrinolysis are safe and effective treatments for paediatric empyema. Both are superior to chest drainage alone. VATS more often achieves resolution with a single procedure, whereas fibrinolysis remains a viable, less-invasive first-line option. Simple parapneumonic effusion requires intravenous antibiotics and supportive care alone. Because allocation was not standardized, differences in reintervention should not be read causally.
METHODS: Database searches across PubMed, Web of Science, Cochrane Library and ScienceDirect (January 2005-May 2025) were conducted following PRISMA guidelines. After exclusions, 22 studies (RCTs and observational) were included. Quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Because studies defined success inconsistently, effectiveness was also expressed as single-procedure success: resolution without a further drainage procedure. Other outcomes included reintervention, hospital stay, complications and mortality.
RESULTS: Included were 18 cohort studies and 4 RCTs (3667 patients; empyema stages 1-3). Evaluated approaches included video-assisted thoracic surgery (VATS), intrapleural fibrinolysis, chest tube drainage and thoracotomy. Study-reported success ranged from 90%-96% with VATS and 70%-95% with fibrinolysis; expressed as single-procedure success, these fell to 67%-100% and 63%-98%, respectively, against 47% for drainage alone. Chest tube duration was often shorter after VATS, although the drain serves a different purpose in each pathway and is not a measure of efficacy. Overall complication rates were low; bronchopleural fistula was reported by only three studies.
CONCLUSIONS: Both VATS and intrapleural fibrinolysis are safe and effective treatments for paediatric empyema. Both are superior to chest drainage alone. VATS more often achieves resolution with a single procedure, whereas fibrinolysis remains a viable, less-invasive first-line option. Simple parapneumonic effusion requires intravenous antibiotics and supportive care alone. Because allocation was not standardized, differences in reintervention should not be read causally.