Source: Annual Congress 2002 - Empyema thoracis in children
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

Not every child with pneumonia is recovering quickly enough. In some cases the pneumonia complicates with pleural effusion. The appropriate management of pediatric empyema thoracis remains controversial. The management of empyema includes initial diagnostic thoracentesis and then - classified as acute or fibropurulent. [dsquote]Fibropurulent[dsquote] empyema is uniformly treated with thoracostomy. If antibiotic therapy and drainage are not effective and the patient remained clinicall unwell, the lung is to be decorticated. The use of fibrinolytic agents such as urokinase and streptokinase (UK/SK) has been reported in cases of empyema in adults. In pediatric patients the experience is, however, very limited.
We used intrapleural instillation of UK/SK in the treatment of loculated pleural effusion in three pediatric patients 2, 4.5 and 11 years of age after failing to respond to I.V. antibiotics and closed-tube thoracostomy drainage. 50,000 IU of diluted urokinase was instilled three times a day via the thoracostomy tube under ultrasound control for 3 days. Two children responded with increased thoracostomy tube drainage and clinical resolution of symptoms. The aggressive surgery intervention - decortication was required in the third case, due to late diagnosis of complicated pneumonia. No bleeding, fever, anaphylaxis, or allergic reactions were noted. The coagulation parameters remained unchanged.
The intrapleural instillation of UK is safe and effective for promoting drainage of loculated intrapleural effusion. It might be a useful option in the treatment of persistent loculations reducing risk of decortication.

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Citations should be made in the following way:
E. Vaitkaitien[edot], J. Kudzyte, R. Kacinskas (Kaunas, Lithuania). Intrapleural instillation of fibrinolytics in the treatment complicated pneumonia in children. Case study. Eur Respir J 2002; 20: Suppl. 38, 3697

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