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Evaluation of a pediatric protocol of intrapleural urokinase for pleural empyema: a prospective study
Giorgio Stefanutti1, Vittorina Ghirardo, Angelo Barbato
1Paediatric Surgery Unit, University of Padova, Padova, Italy.
Insights
This study shows a pediatric urokinase protocol effectively treats pediatric pleural empyema. The size-adjusted dose was safe and optimized drug use in children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Pharmacology
Background:
- Intrapleural urokinase is effective for pediatric pleural effusions.
- Optimal dosing for children remains debated.
- This study evaluated a specific pediatric urokinase protocol.
Purpose of the Study:
- To prospectively assess a pediatric protocol for intrapleural urokinase in treating pleural empyema.
- To determine the safety and efficacy of size-adjusted urokinase dosing in children.
Main Methods:
- Prospective study of 41 children with pleural empyema over 6 years.
- Urokinase (56,000 IU/m(2)) administered intrapleurally twice daily.
- Continued until effusion resolution; surgery considered after 3 days if unsuccessful.
Main Results:
- High success rate with intrapleural urokinase in pediatric pleural empyema.
- Only 9.8% of patients required additional operative procedures.
- No major urokinase-related side effects observed; optimized drug utilization.
Conclusions:
- A specific pediatric urokinase protocol is highly effective as primary treatment for pleural empyema.
- Size-adjusted urokinase dosing is safe and optimizes drug use in pediatric patients.
- This protocol supports efficient management of pediatric pleural effusions.
Background:
Intrapleural urokinase has been shown to be effective in the treatment of pleural effusions in children. However, optimal dosing in children is debated. The aim of this study was to prospectively evaluate a specific pediatric protocol of intrapleural urokinase.
Methods:
All children admitted to a single institution over a 6-year period with a diagnosis of pleural empyema were managed with chest tube and fibrinolytics. Clinical data were collected prospectively. Urokinase (56,000 IU in 56 mL saline/m(2) body surface) was administered twice daily, and was continued until resolution of the effusion. Further operative treatment was considered if urokinase treatment was unsuccessful after >/=3 days. Results are shown as median values (interquartile range).
Results:
Forty-one consecutive children aged 4.4 (3.2-6.9) years were included in the study, and received 420,000 (280,000-750,000) IU of urokinase over 7 (4-8) days. Suction through the chest drain was applied for 8 (6-10) days, and IV antibiotics were discontinued after 12 (10-15) days from the start of intrapleural fibrinolytics. Four children (9.8%) required 5 additional operative procedures (3 thoracoscopic debridements and 2 minithoracotomic debridements). Patients were discharged after 13 (11-16) days from the beginning of intrapleural urokinase. No major side effects attributable to urokinase were observed.
Conclusion:
Intrapleural instillation of urokinase according to a specific pediatric protocol results in a high success rate when applied as a primary treatment in children with pleural empyema. Administration of a size-adjusted dose of urokinase proved to be safe and could optimize drug utilization.
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