Comparison of intrapleural alteplase and combination intrapleural dornase alfa and alteplase therapy for complicated pediatric parapneumonic effusion and empyema
Description
Julie Schlichting, PGY1
Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
Objectives:
1. To gain and apply knowledge on the theory behind why combination interpleural alteplase and dornase alfa is superior to monotherapy interpleural alteplase in the treatment of pediatric empyemas.
2. To develop an understanding behind why interpleural medications improve patient outcomes in those with empyemas.
Abstract:
Introduction: Current treatment of pediatric empyemas involves interpleural alteplase and dornase alfa. The addition of dornase alfa was made when a randomized control adult study showed improved fluid drainage, reduced hospital stay, and reduced frequency of surgical referral compared to monotherapies and placebos. However, the safety and efficacy has only been shown in adults thus far. The purpose of this retrospective review is to compare the effectiveness and safety of high dose alteplase to combination therapy of alteplase and dornase alfa in treating pediatric patients with empyemas caused by pneumonia.
Methods: This study is an observational, retrospective cohort study. Children’s Hospitals and Clinics of Minnesota patients who received interpleural high dose alteplase monotherapy or combination therapy of alteplase and dornase alfa for an empyema secondary to pneumonia will be analyzed. This population will include those ≥1 and <18 years of age with no pre-specified gender requirements who were admitted between June 1, 2013 until December 31, 2018. Effectiveness will be measured using the following outcomes 1) Necessity of surgical intervention after therapy 2) Total chest tube output 3) Date to discharge from chest tube insertion, and duration of chest tube placement. Safety will be measured using the following: 1) anaphylactic reactions 2) pain with medication administration 3) oxygen desaturations during medication administration 4) documentation of significant bleeds 5) any other adverse reaction related to the medications.
Results: Results will be submitted within the final slides.
Conclusion: Conclusion will be submitted within the final slides.
Handout Slides: