Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema.
OBJECTIVE
To describe the use of intrapleural instillation of fibrinolytic agents as adjunctive therapy for children with complicated pleural effusions and empyema.


METHODS
Retrospective chart review.


METHODS
Tertiary care children's hospital in an academic medical center.


METHODS
Nineteen consecutive patients (median age, 36 months; range, 9 months to 13 yrs) with complicated pleural effusion or empyema by clinical, radiographic, and laboratory criteria who failed to have adequate drainage of the fluid collection by tube thoracostomy.


METHODS
Patients who remained symptomatic with fever or respiratory distress and who had pleural fluid that could not be drained by tube thoracostomy were treated by intrapleural instillation of either urokinase (13 patients) or streptokinase (six patients) 8-72 hrs after chest tube insertion.


RESULTS
Fibrinolytic therapy increased the volume of chest tube drainage in 15 (79%) of 19 patients. Fourteen of the 19 patients were successfully managed without referral for surgical drainage. No significant adverse events or side effects were noted.


CONCLUSIONS
Intrapleural instillation of fibrinolytic agents appears to be an effective and less invasive alternative to surgical drainage for children who have complicated pleural effusions or empyemas that do not drain adequately with tube thoracostomy alone.
Cochran
Joel B
JB
Division of Pediatric Emergency/Critical Care, Medical University of South Carolina, Charleston, SC, USA.
Tecklenburg
Fred W
FW
Turner
Ronald B
RB
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007322:Instillation, Drug; D008297:Male; D010996:Pleural Effusion / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator