Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase

Ekíngen, Gülşen; Güvenç, B. Haluk; Sözübir, Selami; Tuzlacı, Ayşe; Şenel, Ufuk

doi:10.1016/j.ejcts.2004.05.032

Cited by 34 publications

(28 citation statements)

References 20 publications

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“…73 The recommended dose is 25 000 IU/kg in 50 to 100 mL in saline intrapleurally via a chest tube with clamping for 4 hours; a total dose of 250 000 IU per instillation should be never exceeded. 69 A study published by Yao et al 65 showed that intrapleural fibrinolytic treatment with streptokinase is safe and effective and it can avert the need for surgery in most cases; safety was measured by the lack of major side effects after streptokinase instillation while efficacy was measured by pleural fluid drainage of 4-fold higher compared to the control group.…”

Section: Fribrinolyticsmentioning

confidence: 99%

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Parapneumonic Effusion in Children

Hendaus

Janahi

2015

Clin Pediatr (Phila)

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Section: Fribrinolyticsmentioning

confidence: 99%

“…21,63 Several studies have shown that fibrinolytics are preferable over chest tube alone in the management of PPE in children. 42,[64][65][66][67][68][69][70] The 3 fibrinolytics that have been in use are streptokinase, urokinase, and tissue plasminogen activator (tPA) ( Table 1). 71 Urokinase.…”

Section: Fribrinolyticsmentioning

confidence: 99%

Parapneumonic Effusion in Children

Hendaus

Janahi

2015

Clin Pediatr (Phila)

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“…6,7 O tratamento com fibrinolítico intrapleural deve ser iniciado precocemente para que se beneficie das vantagens potenciais antes que aderências pleurais graves se formem.…”

Section: 3unclassified

Fibrinolíticos no Tratamento de Derrames Pleurais Complicados

Coelho

Pereira

et al. 2016

Acta Med Port

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Discussão: Na nossa revisão a taxa de sucesso terapêutico encontra-se dentro do esperado, com uma percentagem de falência inferior ao descrito na literatura. Apresentamos a instilação intrapleural de fibrinolítico e a toracoscopia videoassistida num mesmo protocolo de atuação, tendo como primeira linha terapêutica o fibrinolítico. Conclusão: A opção terapêutica apresentada teve uma baixa taxa de falência e permitiu evitar um procedimento cirúrgico mais agressivo. Consideramos que esta é uma opção de tratamento eficaz e que, na nossa amostra, cursou com uma baixa taxa de sequelas. Palavras-chave: Derrame Pleural; Empiema Pleural; Fibrinolíticos. ABSTRACT Introduction:The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital. Material and Methods:A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and December 2013, was undertaken.Results: A total of 37 patients were identified. Mean duration of hospital stay was 17 ± 7.60 days. Chest drain was placed in the first 48 h of hospital admission in most of the patients (89.2%), with a mean of six days of drainage. Treatment failure was reported in 2.7% of cases and was related with effusion recurrence. This patient underwent video-assisted thoracoscopic surgery with the need to convert to open thoracotomy. A favorable outcome was achieved in 96.9 % of cases. Discussion: In our review, therapeutic success rate was as expected, with a failure rate below those reported in literature. We present intrapleural instillation of fibrinolytics and video-assisted thoracoscopic surgery as part of the same protocol, in which fibrinolytic therapy is the first-line treatment. Conclusion:The therapeutic option presented shows a low failure rate and avoids a more aggressive surgical procedure. We consider this an effective treatment option, with low sequelae rate.

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“…Yıllar içinde torakoskopik debridmanın getirdiği düşük morbidite ve yük-sek etkinlik nedeniyle torakoskopik debridman altın standart yöntem haline gelmiştir. Son yıllarda toraks tüpünden yapılan fibrinolitik tedavinin yalnızca toraks tüpü ile drenaja göre çok daha etkin olduğu gözlem-lenmiştir (24)(25)(26) . Toraks tüpünden verilen ürokinaz ve serum fizyolojiğin etkinlikleri karşılaştırıldığında, ürokinazın hastanede kalış süresi ve tedavi başarısında serum fizyolojiğe göre daha etkili olduğu saptanmıştır (22) .…”

Section: Fibrinolitik Tedavi Işlemiunclassified