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[Intrapleural fibrinolytic treatment and infectious pleuresies: three pediatric cases]
C Trouilloud1, L Pedespan, J L Demarquez
1Service de soins intensifs pédiatriques, hôpital Pellegrin-Enfants, 33076 Bordeaux, France.
Insights
Fibrinolytic agents may effectively treat pediatric pleural effusions, potentially reducing hospital stays and surgical needs. Further prospective studies are needed to confirm clinical utility in children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Loculated pleural effusions can lead to complicated outcomes, including empyema.
- Intrapleural fibrinolytic agents are a proposed treatment for complex pleural effusions.
- Current consensus on using fibrinolytic agents in pediatric patients is lacking.
Observation:
- This case series reports on three children treated for infectious pleural effusion.
- Treatment involved intrapleural fibrinolytic agents combined with standard drainage.
- Successful outcomes were observed in all three pediatric patients.
Findings:
- Fibrinolytic therapy, alongside drainage, demonstrated successful treatment in pediatric cases.
- The study highlights a potential non-surgical approach for complicated pleural effusions in children.
- This suggests a possible reduction in hospitalization duration and need for further surgery.
Implications:
- Prospective studies are essential to validate the clinical utility of fibrinolytic agents in pediatric pleural effusions.
- Evidence is needed to establish optimal protocols and confirm benefits like reduced hospital stay and surgical intervention.
- This approach may offer a valuable alternative for managing pediatric empyema and complicated effusions.
Unlabelled:
Intrapleural instillation of fibrinolytic agents has been proposed for the treatment of loculated pleural effusions, or whenever the biochemical characteristics of the pleural fluid (pH, glucose level, LDH) indicate the risk of a complicated outcome due to a pleural effusion with complications and the possible development of empyema. At present, there is no consensus regarding the use of intrapleural fibrinolytic agents in children.
Case Reports:
In this study, the successful treatment by fibrinolytic agents and standard drainage are successfully performed in three children with a pleural effusion due to an infection.
Conclusion:
The clinical utility, in terms of the reduction of the duration of hospitalization and additional surgical treatment, should be assessed in prospective studies.