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Dosage and effectiveness of intrapleural doxycycline for pediatric postcardiotomy pleural effusions
David S Hoff1, David B Gremmels, Karen M Hall
1Department of Pharmacy, Children's Heart Clinic at Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404, USA. david.hoff@childrensmn.org
Insights
Intrapleural doxycycline effectively treated persistent postcardiotomy pleural effusions in pediatric patients, with a 94% success rate. This treatment offers a viable option for managing these challenging post-cardiac surgery complications.
Area of Science:
- Pediatric critical care medicine
- Thoracic surgery
- Pharmacology
Background:
- Post-cardiotomy pleural effusion is a common complication following congenital heart disease surgery.
- Persistent pleural effusions requiring prolonged chest tube drainage can lead to increased morbidity in pediatric patients.
- Limited effective treatment options exist for managing persistent effusions after cardiac surgery in children.
Purpose of the Study:
- To evaluate the efficacy of intrapleural doxycycline administration for treating postcardiotomy pleural effusions in pediatric patients.
- To determine the success rate and time to resolution of pleural effusions treated with doxycycline pleurodesis.
- To identify potential adverse effects associated with intrapleural doxycycline use in this population.
Main Methods:
- A retrospective case series design was employed.
- Twelve pediatric patients with persistent pleural effusions (drainage >7 days) post-cardiotomy for congenital heart disease were included.
- Intrapleural doxycycline was administered via chest tube, retained for 6 hours, and followed by suction drainage.
Main Results:
- The overall treatment success rate was 94% (17 of 18 courses).
- Mean time to treatment success was 76 hours, and mean chest tube removal time was 130 hours.
- Chest pain was the most frequent adverse event; doxycycline concentration did not correlate with success.
Conclusions:
- Intrapleural doxycycline infusion is an effective treatment for persistent postcardiotomy pleural effusions in pediatric patients.
- The procedure demonstrated a high success rate and relatively rapid resolution of effusions.
- Doxycycline pleurodesis represents a valuable therapeutic option for this specific clinical scenario.
Study Objective:
To determine the effectiveness of intrapleural doxycycline for the treatment of postcardiotomy pleural effusions in pediatric patients.
Design:
Retrospective case series.
Setting:
Intensive care unit in a pediatric tertiary care center.
Patients:
Sequential sample of 12 pediatric patients who underwent cardiotomy for congenital heart disease and received doxycycline pleurodesis for persistent pleural effusion that lasted more than 7 days between December 21, 2001, and May 23, 2005.
Measurements And Main Results:
Mean age of the patients was 1 year (range 2 wks-2.5 yrs). Eighteen courses of doxycycline were administered among the 12 patients. An average dose of 19.1 mg/kg/dose of parenteral doxycycline was diluted in normal saline to a final syringe concentration of 2-8 mg/ml and injected through a chest tube. The patient was rotated according to a protocol. The doxycycline dose remained in the pleural space for approximately 6 hours before being drained under suction. Treatment success was defined as achievement of 0-ml/hour chest tube output after a doxycycline dose. The overall treatment success rate was 94% (17 of 18 courses). The mean times from dosing to treatment success and chest tube removal were 76 hours (range < 1 to 140 hrs) and 130 hours (range 8-453 hrs), respectively. Seventy-two percent of the courses (13 of 18) achieved treatment success within 96 hours and chest tube removal within 168 hours after dosing. Doxycycline concentration did not appear to be related to treatment success. Chest pain was the most common adverse effect.
Conclusion:
Intrapleural doxycycline infusion is effective for postcardiotomy pleural effusion in pediatric patients with persistent chest tube drainage lasting more than 7 days.
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