| 11 th Annual Pediatric Critical Care Colloquium |
| Session/Time | Pulmonary I/Thu, 9:45 - 12 00 PM |
| Title | Preventing Surgical Intervention for Parapneumonic Effusions with Multiple Doses of Urokinase |
| Author | B Tyminska, A Burkowsky, WE Edge, JL Sanchez |
| Affiliation | Division of Pediatric Critical Care, Children’s Hospital at Albany Medical Center, Albany, New York |
| Introduction | The treatment of parapneumonic effusions remains controversial. No controlled studies have been published in children comparing early decortication versus the instillation of fibrinolytic agents in thoracostomy drainaae tubes. Additionally, no consensus exists on the type of fibrinolytic agent (urokinase or streptokinase) or dose frequency (sinale versus multiple daily dosing). We reviewed our experience with persistent parapneumonic effusion io identify the best treatment modality. |
| Method | A retrospective review. of all cases of persistent parapneumonic effusion between January 1991 and June 1998 was done. Patients with past chest suraery and/or traumatic effusion were' excluded. No patient in this study had underlying cardiac, collauen vascular, mati-nant, or pulmonary disease. Data obtained included aae, sex, pleural fluid analysis, febrile days, and length of stay. RESULTS: Thera were a total of '37 patients with empyema or oraanized pleural effusion. Twenty patients were treated with thoracostomy drainage only. Thirteen required suraical decortication. Seventeen patients were treated with thoracostomy plus the instillation of a fibrinolytic acent, in a sinale daily dose or multiple daily doses re-iment. Three of ten patients receivi a sinale daily doses required surcical decortication. Of the seven patients receiving multiple daily doses none required decor-tication. The multiple dose patients had shorter length of stay (8.0 SD 2.6 vs. 10.64 SD ).O; p =.09) and shorter febrile period (1.25 SD 1.25 vs. 6.0 SD 2.4, p = .001). There was no statistical significance in acv-,, lenatli of chest tribe placement, or pleural fluid analysis ber veen -ROLIPS |
| Result | Thera were a total of 37 patients with empyema or oraanized pleural effusion. Twenty patients were treated with thoracostomy drainage only. Thirteen required suraical decortication. Seventeen patients were treated with thoracostomy plus the instillation of a fibrinolytic acent, in a sinale daily dose or multiple daily doses re-iment. Three of ten patients receiving single daily doses required surcical decortication. Of the seven patients receiving multiple daily doses none required decor-tication. The multiple dose patients had shorter length of stay (8.0 SD 2.6 vs. 10.64 SD 3.O; p =.09) and shorter febrile period (1.25 SD1.25 vs. 6.0 SD 2.4, p = .001). There was no statistical significance in age, length of chest tribe placement, or pleural fluid analysis between groups |
| Conclusion | Our data suggest that multiple daily doses of fibrinolytic agent decreases the length of the febrile period and the length of stay in children with parapneumonic effusion and is efficacious in reducing the need for surgical intervention. |
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