Related Experiment Videos
Use of urokinase in childhood pleural empyema
A Barbato1, C Panizzolo, C Monciotti
1Department of Pediatrics, University of Padua, Padua, Italy.
Insights
Urokinase (UK) treatment for pediatric parapneumonic pleural empyema reduced hospital stays and the need for pleural debridement surgery. This fibrinolytic enzyme did not increase the risk of pneumothorax in children.
Area of Science:
- Pulmonology
- Pediatric Medicine
- Enzymology
Background:
- Parapneumonic pleural empyema is a common pediatric condition requiring drainage.
- Urokinase (UK), a fibrinolytic enzyme, is used to facilitate chest tube drainage.
- The safety and efficacy of UK in pediatric empyema require further evaluation.
Purpose of the Study:
- To assess the risk of pneumothorax, need for pleural debridement surgery, fever persistence, and hospital stay in children with parapneumonic pleural empyema treated with urokinase.
- To compare outcomes in UK-treated children with a historical control group.
Main Methods:
- An uncontrolled retrospective study comparing 17 children treated with urokinase to 11 historical controls.
- Urokinase was instilled intrapleurally over 2-8 days.
- Outcomes assessed included pneumothorax, need for surgery (drainage/debridement), fever, and hospital duration.
Main Results:
- No significant difference in pneumothorax rates between groups (3 in UK group vs. 3 in historic group).
- Significantly fewer children required pleural debridement in the UK group (5/17) compared to the historic group (9/11) (P=0.02).
- Hospital stay was significantly shorter for the UK group (17 days) versus the historic group (24 days) (P=0.02).
Conclusions:
- Urokinase treatment for pediatric parapneumonic pleural empyema is safe, with no increased risk of pneumothorax.
- Urokinase significantly reduces the need for pleural debridement surgery and shortens hospital stay.
- Urokinase is a valuable therapeutic option for pediatric empyema management.
Abstract:
Urokinase is an enzyme with a fibrinolytic effect that facilitates pleural empyema drainage through a chest tube. The aim of this study was to assess the risk of pneumothorax, the need for pleural debridement surgery, the persistence of fever, and the number of days in hospital in a group of children with parapneumonic pleural empyema treated with urokinase. This was an uncontrolled retrospective study on children suffering from parapneumonic empyema. Data collected on 17 children treated with urokinase were compared with 11 children treated prior to the advent of urokinase (the "historic" group). The urokinase was instilled in the pleural cavity over a period ranging from 2-8 days, amounting to a median total dose per kilogram of body weight of 18,556 IU (range, 7,105-40,299). Surgical treatment of the empyema involved drainage tube placement and/or debridement of the pleural cavity. Three children developed pneumothorax during their hospital stay, and one more case occurred 6 months after the child had recovered from his empyema; there were 3 cases of pneumothorax during the acute phase in the "historic" group (P = 0.54). Five children in the urokinase group were debrided and 12 were only drained, as opposed to 9 and 2, respectively, in the "historic" group (P = 0.02). The overall hospital stay was 17 days for the urokinase group, and 24 for the "historic" group (P = 0.02). No bleeding or other major complications were reported in the group treated with urokinase. In conclusion, urokinase treatment does not carry a risk of pneumothorax, while it does reduce hospital stay and the need for pleural debridement.