Streptokinase fibrinolysis protocol: the advantages of a non-operative treatment for stage II pediatric empyema patients.
BACKGROUND
Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established.


OBJECTIVE
To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration.


METHODS
We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009. Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainage


RESULTS
Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, p = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P= 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs.11.70 +/- 5.74 days, P= 0.301).


CONCLUSIONS
Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.
Department of General Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel. d_faber@rambam.health.gov.il
Dan Levy
DL
Faber
Lael Anson
LA
Best
Michael
M
Orlovsky
Moshe
M
Lapidot
Rony-Reuven
RR
Nir
Ran
R
Kremer
D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D013300:Streptokinase / Q000008:administration & dosage*
D005343:Fibrinolytic Agents; D013300:Streptokinase