Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas.

AIM: The aim of this paper was to compare the efficacy of adjunctive intrapleural fibrinolygic agents (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema.

METHODS: In our clinic, we used intrapleural fibrinolytic agents in 78 pediatric patients (36 fibrinopurument stage empyemas, 42 chronic stage empyemas) between December 1994 and September 2002. Pleural biopsy was done for staging. Streptokinase 250,000 units in 100 ml 0.9% saline solution (62 patients) and 125000 units in 100 ml 0.9% saline solution (16 patients) was instilled daily to the chest tube, and the tube was clamped for 4 h followed by suction. This treatment was continued daily for 2 to 8 days until resolution was demonstrated by chest radiograms and/or computed chest tomography.

RESULTS: The treatment was discontinued due to allergic reaction and pleural hemorrhage in 1 patient with fibrinopurulent empyema. This patient died 1 day later in a septic condition. The regimen was completely successful in 24/36 (66.6%) fibrinopurulent empyemas, and partially successful in other 11/36 (30.55%). Treatment was ineffective in 38 of 42 patients with chronic empyemas (90.6%). Two cases in chronic phase empyema completely recovered and 2 other patients had a partial response. Success of the treatment was 91.66% (35/36) (complete response: 24/36' partial response 11/36) in the fibropurulent stage and 9.4% (2/42 complete response, 2/42 partial response in chronic cases.

CONCLUSIONS: Our study suggests that intrapleural fibrinolytic treatment is an effective and safe therapy in children with fibrinopurulent phase thoracic empyema.