TREATMENT OF LOCULATED PLEURAL EFFUSION WITH INTRAPLEURAL UROKINASE IN CHILDREN

Background/Purpose: The use of fibrinolytic agents such as urokinase a nd streptokinase has been reported in cases of empyema in adults. In p ediatric patients the experience is, however, very limited. Methods: A series of seven consecutive children who had loculated pleural effusi on that did ndt respond to drainage and antibiotics is reported. Resul ts: In all cases, the effusion was found to be multiloculated. Urokina se (UK) instillation through the already existing chest tube was start ed. A dose of 100,000 U of UK diluted in 100 mt of normal saline was i nstilled through the chest tube, which was clamped for 12 hours and th en was left open for another 12 hours. In six of seven children, the t reatment was terminated after complete or almost complete resolution w as attained. This was achieved within 5 treatment days (mean, 3.3). Th ere was one failure which was attributed to relatively late initiation of treatment. No complications were observed. Conclusions. The author s conclude that intrapleural administration of UK is a safe and effici ent method of treatment in cases of loculated pleural effusions in chi ldren. UK instillation to the intrapleural space should be considered: early before initiating surgical intervention. Starting intrapleural U K treatment Should not be delayed. Copyright (C) 1997 by W.B. Saunders Company.