Efficacy and safety of early intrapleural instillation of streptokinase in the treatment of complicated parapneumonic empyema in children
Abstract
Introduction: in January 2005, a protocol was implemented at the Pereira Rossell Hopital Centre, for the administration of intrapleural streptokinase (STK) as an alternative to surgical treatment of complicated empyema. Intrapleural STK, when administered in the first eight days subsequent to the placing of the drainage diminished the duration of thoracic drainage, the need for thoracotomy and a prolonged stay in hospital. In 2007, the initial protocol was modified. Thorax X-rays examinations or surgery findings began to be used for the diagnosis of complicated empyema, and STK instillation started to be indicated 12 to 36 hours after thoracic drainage.
Objective: to describe results of early intrapleural instillation of streptokinase in children hospitalized with complicated parapneumonic empyema, and to compare them to the results obtained after instillation during the first eight days subsequent to the placement of thoracic drainage.
Method: children with complicated parapneumonic empyema that were hospitalized from April 1, 2005 through September 30, 2007 were included in the study. They were divided into two cohorts. Historical: children hospitalized from April 1, 2005 and August 1, 2006, when diagnosis of complicated empyema was made according to clinical and ecographic criteria, who received intrapleural STK during the first eight days subsequent to the placement of thoracic drainage. Prospective: children hospitalized from March 1, 2007 and September 30, 2007, diagnosed and treated according to the new protocol. Evolution was compared through the following variables: duration of thoracic drainage, complications, need for thoracotomy, duration of hospital stay and death.
Results: both groups were comparable. Duration of hospital stay and thoracic drainage were lower in children treated with early intrapleural STK (p<0,05). Two children required thoracotomy, one in each cohort group. The number and type of complications was similar in both groups. None of the patients included in the study died.
Conclusions: early intrapleural instillation of STK constitutes a therapeutic alternative in the treatment of children with complicated parapneumonic empyema.
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