Comparison of Intrapleural Urokinase and Video-Assisted Thorascopic Surgery in the Treatment of Parapneumonic Pleural Effusion in Children

Prospective Randomized Study Comparing the Efficacy and Safety of Pleural Drainage by Video-Assisted Thoracoscopic With Pleural Drainage by Percutaneous Drain Associated With Urokinase in the Treatment of Parapneumonic Pleural Effusion in Children

Despite the improvement in the technology available for diagnosing and treating empyema, the management of empyema in children remains controversial.

The purpose of this study is to compare the efficacy and safety of two common technical approach used for pleural effusion drainage in the treatment of childhood empyema.

Inclusion Criteria:

• patients under the age of 17

• pleural fluid depth of at least 15mm, confirmed by ultrasound

• at least one of the following severity criteria :

  1. fever continuing 48h after starting correct antibiotherapy
  2. respiratory distress
  3. mediastinal displacement on the chest X-ray

Exclusion Criteria:

• previous drainage by either Video-Assisted Thoracoscopic or pleural drainage by percutaneous drain associated with urokinase- congenital pulmonary disorders with lung function impairment
• congenital pulmonary disorders with lung function impairment
• chronic pulmonary disease associated with lung function impairment
• hemodynamic instability
• congenital immunodeficiency disease
• secondary immune deficiency induced
• hemostasis disorder (contraindication of thrombolytic therapy)
• pregnancy or breastfeeding patient