[Intrapleural streptokinase in the treatment of complicated parapneumonic empyema].
BACKGROUND
Parapneumonic empyema is a frequent cause of admission in the Pediatric Hospital of the Pereira Rossell Hospital Center. In January 2005, we implemented a treatment protocol that included intrapleural streptokinase (STK) for children with complicated parapneumonic empyema as an alternative to surgery.


OBJECTIVE
To describe the results of intrapleural STK in the treatment of hospitalized children with complicated parapneumonic empyema and to compare these results with those of early thoracotomy.


METHODS
Children with complicated parapneumonic empyema admitted between January 1st 2004 and October 1st 2005 were included. The children were divided into two groups: a historical group, composed of children hospitalized between January 1st and December 31st 2004, treated with conventional thoracotomy before day 8 of chest drain placement and a prospective group, composed of children hospitalized between January 1st and October 1st 2005, treated with intrapleural STK before day 8 of chest drain placement. The variables used to compare outcome and treatment complications were duration of chest tube drainage after the treatment procedure, complications, re-admission, length of hospital stay, and death.


RESULTS
The results in both groups were similar. Length of hospital stay showed no significant differences. Duration of chest tube drainage after intrapleural STK was significantly shorter than after thoracotomy (p < 0.001). In the thoracotomy group a significantly higher proportion of patients required partial atypical pneumonectomy (p = 0.051). There were no deaths.


CONCLUSIONS
Intrapleural STK is a valid alternative for the treatment of children with complicated parapneumonic empyema.
Fernández Fernández
A
A
Unidad Médico-Quirúrgica de Asistencia de Niños con Empiema, Laboratorio de Bioestadística, Departamento de Biofísica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Giachetto Larraz
G
G
Giannini Fernández
G
G
Garat Gómez
M C
MC
Vero Acevedo
M A
MA
Pastorini Correa
J
J
Castillo Casati
C
C
Pírez García
M C
MC
Servente Luquetti
L
L
Ferrari Castilla
A M
AM
D002675:Child, Preschool; D004322:Drainage; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D013300:Streptokinase / Q000008:administration & dosage*; D013908:Thoracotomy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase