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Urokinase in the management of complicated parapneumonic effusions in children
S Krishnan1, N Amin, A J Dozor
1Department of Pediatrics, New York Medical College, Valhalla 10595, USA.
Insights
Intrapleural urokinase effectively treated complicated parapneumonic effusions in children, improving drainage and symptoms. This safe treatment may help avoid surgery and reduce hospital stays for pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Pharmacology
Background:
- Complicated parapneumonic effusions are common in children.
- Intrapleural fibrinolytic agents are used in adults to improve drainage and avoid surgery.
- Limited data exists on urokinase use in pediatric complicated parapneumonic effusions.
Purpose of the Study:
- To evaluate the efficacy and safety of intrapleural urokinase in pediatric patients with complicated parapneumonic effusions.
- To determine if urokinase can help obviate the need for surgery in children.
- To assess the impact of urokinase on drainage and clinical outcomes.
Main Methods:
- Retrospective review of nine children (6 months to 6 years) with complicated parapneumonic effusions.
- Intrapleural urokinase (20,000 IU) instilled three times daily for 3 days via thoracostomy tube.
- Four patients underwent thoracoscopic adhesiolysis prior to urokinase instillation.
Main Results:
- Eight of nine subjects showed clinical improvement and increased drainage after 3 days of urokinase.
- One subject responded to a second course of treatment.
- The procedure was well-tolerated with no significant adverse events or changes in coagulation parameters.
Conclusions:
- Intrapleural urokinase is a safe and effective adjunct for managing complicated parapneumonic effusions in children.
- Urokinase may be a viable option to prevent surgery and potentially shorten hospitalization in pediatric patients.
- Further research is warranted to establish optimal protocols for pediatric use.
Objective:
Use of intrapleural fibrinolytic agents in the management of complicated parapneumonic effusions has been widely reported in adults. Such agents promote drainage of fluid through the thoracostomy tube and may obviate surgery. Both streptokinase and urokinase have been used for this purpose, but there are few reports of their use in the children. The objective of this study was to evaluate the role of intrapleural urokinase in the management of complicated parapneumonic effusions in children.
Methods:
We reviewed the hospital course of nine children, ages 6 months to 6 years, with complicated parapneumonic effusions who received intrapleural urokinase after failing to respond to I.V. antibiotics and closed-tube thoracostomy drainage. Four subjects had additional thoroscopic adhesiolysis before intrapleural instillation of urokinase; 20,000 IU of diluted urokinase was instilled three times a day via the thoracostomy tube for 3 days.
Results:
Eight subjects responded to 3 days of urokinase instillation, with increased thoracostomy tube drainage and clinical resolution of symptoms. The remaining subject responded to a second course of instillation. Two subjects needed oral analgesic for transient chest pain. All subjects tolerated the procedure well. No bleeding, fever, anaphylaxis, or allergic reactions were noted. The coagulation parameters remained unchanged.
Conclusion:
Intrapleural instillation of urokinase appears to be a useful and safe adjunct in the management of complicated parapneumonic effusions in children. Its use may be considered in potential decortication patients in an effort to prevent surgery and possibly shorten hospitalization.