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Management of thoracic empyema in children
Nizamettin Kiliç1, Solmaz Celebi, Arif Gürpinar
1The Medical Faculty of Uludag University, Department of Paediatric Surgery, Bursa, Turkey.
Insights
Fibrinolytic treatment effectively resolves pediatric thoracic empyema in 80% of cases. This adjunctive therapy is safe and can often prevent the need for surgery in children with this condition.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Medical Microbiology
Background:
- Thoracic empyema is a serious infection in children.
- Limited data exists on fibrinolytic treatment efficacy in pediatric patients.
- Established treatment includes antibiotics and chest tube drainage, but may require surgery.
Purpose of the Study:
- To evaluate the success and complication rates of fibrinolytic treatment for pediatric thoracic empyema.
- To assess the safety and effectiveness of intrapleural fibrinolytic agents in children.
- To determine if fibrinolytic therapy can reduce the need for surgical intervention.
Main Methods:
- Retrospective case series of 25 pediatric patients with loculated pleural empyemas.
- Patients received intrapleural urokinase or streptokinase after failure of antibiotics and tube thoracostomy.
- Treatment duration, chest tube drainage duration, and outcomes were analyzed.
Main Results:
- 80% of patients (20/25) showed significant improvement with fibrinolytic therapy, including increased fluid output and near-complete effusion resolution.
- Mean fibrinolytic treatment duration was 4.3 days; mean chest tube drainage was 8.9 days.
- Complications occurred in 20% (5/25) and were managed surgically.
Conclusions:
- Intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy for pediatric thoracic empyema.
- This approach can potentially obviate the need for thoracotomy in a majority of pediatric cases.
- Fibrinolytic therapy offers a promising alternative for managing complex pediatric empyema.
Abstract:
The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim of this study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from 1 to 12 years (mean 4.2). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multiloculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.