Abstract

BACKGROUND
Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established.
OBJECTIVES
To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration.
METHODS
We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009. Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainage
RESULTS
Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, p = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P= 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs.11.70 +/- 5.74 days, P= 0.301).
CONCLUSIONS
Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.

Links

Publisher Full Text

Authors

Faber DL, Best LA, Orlovsky M, Lapidot M, Nir RR, Kremer R

Institution

Department of General Thoracic Surgery, Rambam Health Care Campus, Haifa, Israel. d_faber@rambam.health.gov.il

Source

The Israel Medical Association journal : IMAJ 14:3 2012 Mar pg 157-61

MeSH

Bronchoalveolar Lavage
Child
Child, Preschool
Clinical Protocols
Empyema, Pleural
Female
Fibrinolytic Agents
Humans
Intensive Care Units, Pediatric
Male
Retrospective Studies
Streptokinase

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22675854