Selvadurai Y; The Sydney Children’s Hospitals Network, Westmead, New
South Wales, Australia & Royal North Shore Hospital, St Leonards, New South
Wales, Australia.
Kennedy B; Mcbride J; Field P; et al

BMJ open respiratory research. 13(1), 2026 Jul 30.

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.