Treatment of encapsulated pleural effusions in children: a prospective trial.
BACKGROUND
The aim of this study was to improve the efficacy of treatment of complicated pleural effusions.


METHODS
In this prospective study, 76 consecutive children (average age 5.0 +/- 4.14 years) fulfilling the required classification criteria were duly treated with chest tube placement and divided into two groups depending on the presence of encapsulated or non-encapsulated effusions. Treatment of the former group was supplemented by intrapleural fibrinolysis. The effectiveness of treatment was assessed in terms of chest tube dwell-time and total length of hospitalization. Regression analysis was performed using independent factors that were associated with these dependent factors. Value differences for P < 0.05 were considered significant.


RESULTS
The ultrasound pleural distance and lactic-dehydrogenase content in the pleural fluid was significantly associated with the length of treatment (P < 0.01). Improved response to treatment, reduced duration of hospitalization (9.2 +/- 1.9 vs 11.5 +/- 0.9; P < 0.01) and tube dwell-time (7.6 +/- 1.3 vs 9.5 +/- 0.9; P < 0.01) was achieved in the intrapleural-fibrinolysis-treated group (n= 38) compared with controls (n= 38), with virtually the same total tube output (606.1 +/- 257.5 vs 673.1 +/- 347.4; P= 0.175). All patients were completely cured. Following 104 applications of the fibrinolytic agent there was one change in coagulation parameters: hypofibrinogenemia (in 1%).


CONCLUSIONS
The authors recommend intrapleural fibrinolysis as an effective and safe alternative treatment strategy in treating encapsulated pleural effusions in children.
Kobr
Jiri
J
Department of Paediatrics-PICU, Faculty of Medicine in Pilsen and Faculty Hospital in Pilsen, Czech Republic. jiri.kobr@lfp.cuni.cz
Pizingerova
Katerina
K
Sasek
Lumir
L
Fremuth
Jiri
J
Siala
Konrad
K
Racek
Jaroslav
J
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013300:Streptokinase / Q000008:administration & dosage*; D016896:Treatment Outcome; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D005343:Fibrinolytic Agents; D013300:Streptokinase