Fibrinolytic therapy in pediatric age empyema

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Fibrinolytic therapy in pediatric age empyema []

. 2004; 18(3): 110-114

Fibrinolytic therapy in pediatric age empyema

G�l�en Ekingen¹, Haluk G�ven�¹, Selami S�z�bir¹, Metin Aydo�an², Ay�e Tuzlac�¹, Ay�e G�kalp²
¹Kocaeli University Faculty of Medicine, Department of Pediatric Surgery, �zmit
²Kocaeli University Faculty of Medicine, Department of Child Health and Diseases, �zmit

INTRODUCTION: In complicated effusions the increased production of fibrin results in formation of loculations and septations within the thoracic cavity, leading to ineffective chest tube drainage. Intrapleural fibrinolytic agents are employed to avoid thoracotomy in such complicated pleural effusions. Our study reviews the results of streptokinase treatment in children with pleural disease beyond the exudative stage following tube thoracostomy.
METHODS: Between October 2001-December 2002, twentytwo patients with pleural effusions were admitted to our hospital. Twenty-one patients were inserted a chest tube. Ninetene patients were treated with intrapleural stertokinase. Intrapleural streptokinase treatment was started in an average of two days following initial chest tube placement in complicated plevral effusion. The effectiveness of the therapy was assessed by monitoring the volume of the fluid, the level of LDH, Glucose and pH pre and post instillation.
RESULTS: Nineteen patients were treated by intrapleural streptokinase instillation. Mean of total number of instillations were 2.8 (1-4) in patients. The chest tube was removed at a mean of 9.51�5.82 days following completion of streptokinase instillation. The total length of hospital stay was 25.2�12.36 days in the group of treatment with streptokinase. A significant difference was also determined in the pleural LDH, glucose and pH, pre and post treatment. Four patients developed bronchopleural fistula and all of
fistula healed spontaneously. Finally, surgical intervention was necessary in two intractable cases.
DISCUSSION AND CONCLUSION: Intrapleural streptokinase is an effective and safe adjunct in facilitating complete drainage of complicated empyemas.

Keywords: Pleural effusion, intraplevral fibrinolytic therapy, streptokinase

�ocukluk �a�� ampiyem olgular�nda fibrinolitik tedavi

G�l�en Ekingen¹, Haluk G�ven�¹, Selami S�z�bir¹, Metin Aydo�an², Ay�e Tuzlac�¹, Ay�e G�kalp²
¹Kocaeli �niversitesi T�p Fak�ltesi, �ocuk Cerrahisi Anabilim Dal�, �zmit
²Kocaeli �niversitesi T�p Fak�ltesi, �ocuk Sa�l�� ve Hastal�klar� Anabilim Dal�, �zmit

G�R�� ve AMA�: Komplike parapn�monik eff�zyonlu olgular�n tedavisinde, t�p torakostomi ile her zaman etkili bir drenaj sa�lanamayabilir. Bu nedenle komplike plevral eff�zyon tedavisinde fibrinolitik ajanlar�n kullan�m� �nerilmektedir. �al��mada, komplike plevral eff�zyonlu olgular fibrinolitik ajan olarak streptokinaz uyguland� ve bu tedavinin etkisinin de�erlendirilmesi ama�land�.

Y�NTEM ve GERE�LER: Ocak 2001-Aral�k 2002 tarihleri aras�nda, pn�moniye ba�l� plevral eff�zyonlu 22 olgu ba�vurdu. T�m olgulara ikili antibiyotik tedavisi verildi. Eksudatif evredeki�� olgu sadece torasentez ve/veya t�p torakoskopi ile, komplike eff�zyon evresindeki 19 olgu t�p torakoskopi ve intraplevral streptokinaz uygulanarak tedavi edildi. Streptokinaz uygulanan ve uygulanmayan olgularda ba�vuru s�ras�nda mevcut �ik�yetlerinin s�resi, t�p kal�� ve hastanedeki yat�� s�resi tespit edildi. Streptokinaz uygulanan olgularda tedavi �ncesi ve sonras� plevral s�v�n�n toplam drenaj miktar� ve biyokimyasal parametrelerin de�i�iklikleri
de�erlendirildi.

BULGULAR: Ya� ortalamas� 3.95 ya� (6 ay-10y) olan on d�rt k�z, sekiz erkek toplam 22 plevral eff�zyonlu olgunun 21�ine g��s t�p� tak�ld�. Bu olgulardan 19�una t�p tak�ld�ktan ortalama iki g�n sonra intraplevral streptokinaz uyguland�. Drene olan plevral s�v� miktar� ve USG bulgular�n�n sonu�lar�na g�re ortalama 2.8 kez (1-4) doz tekrar� yap�ld�. �ik�yetlerin ba�lang�c� ile ba�vuru aras�nda ge�en
s�re SK uygulanmayan olgularda 5.32 g�n, uygulanan olgularda 9.78 g�nd�. SK uygulanan olgular�n plevral s�v� analizlerinde, tedavi sonras� drene olan s�v� miktar�nda art�� ve biyokimyasal analizlerinde (Glukoz, pH ve LDH) belirgin de�i�iklik kaydedildi. SK uygulanan olgularda ortalama t�p s�resi 9.51�5.82 (3-30) g�nken yat�� s�resi 25.2�12.36 (14-45) g�n olarak tespit edildi. Bronkoplevral fist�l� olan d�rt olgu takip s�ras�nda kendili�inden d�zeldi. �ki olguda tedaviye ba�l� yeterli d�zelme olmad��ndan
cerrahi giri�im uyguland�. SK uygulamas�na ba�l� % 89.4 oran�nda ba�ar� tespit edildi.

TARTI�MA ve SONU�: �ocuk ampiyem olgular�n�n tedavisinde intraplevral streptokinaz uygulamas�n�n etkili ve g�venilir bir drenaj sa�lad��n� d��nmekteyiz.

Anahtar Kelimeler: Plevral eff�zyon, fibrinolitik tedavi, streptokinaz

G�l�en Ekingen, Haluk G�ven�, Selami S�z�bir, Metin Aydo�an, Ay�e Tuzlac�, Ay�e G�kalp. Fibrinolytic therapy in pediatric age empyema. . 2004; 18(3): 110-114

Corresponding Author: G�l�en Ekingen, T�rkiye

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