• Megan K Fuller and Michael A Helmrath.
• Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
• Curr. Opin. Pediatr. 2007 Jun 1; 19 (3): 328-32.

Purpose Of ReviewPneumonia in children is frequently complicated by pleural effusions, which rarely progress to empyema. Appropriate clinical management depends on correctly diagnosing the stage of the disease process. Recently, increasing use of video-assisted thoracic debridement has altered the traditional management of pleural effusions and empyema in children, resulting in decreasing reliance on thoracentesis and earlier surgical intervention.Recent FindingsWe review the current literature supporting the clinical indications for video-assisted thoracic debridement compared with traditional management, including the use of thoracentesis, chest tube placement, fibrinolytic therapy and open thoracotomy in children with empyema. Recent studies support the early application of video-assisted thoracic debridement in children with empyema compared with traditional therapy, as it decreases the number of procedures and studies performed and the duration of chest tube drainage and is associated with less pain and shorter recovery period than open thoracotomy.SummaryWe propose a clinical algorithm supporting the early use of video-assisted thoracic debridement in the management of empyema in children.

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