Role of Intrapleural Urokinase in Empyema Thoracis
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To study the role of fibrinolytic therapy in pediatric empyema in relation to duration of hospital stay, need for surgical intervention and survival to discharge.
Retrospective analysis of case records of children <16 y of age admitted in a tertiary care hospital during January 2013 – December 2017 with diagnosis as empyema thoracis was done. Clinico-laboratory characteristics and the primary and secondary outcomes between the group which received intrapleural urokinase (IPU) and the group which did not (non IPU), were compared.
Of the 84 cases, 40 children received IPU. Mean duration of hospital stay in IPU group (17.51 + 4.57 d) was significantly less than non IPU group (24.32 + 10.18 d, CI –10.19 to −3.64, p < 0.001), so was the duration of intercostal drain (ICD) insertion (9.08 + 3.12 d – IPU group vs. 11.20 + 3.95 d – non IPU group, CI –3.68 to −0.50, p < 0.01). No statistically significant difference was found between the groups with regard to need for surgical intervention [IPU – 4 (10%), non IPU – 9 (20.4%), p = 0.23]. There was no mortality or adverse reaction to urokinase in either group.
IPU holds promising results in terms of reduction of hospital stay and duration of ICD insertion. It may be the initial choice of treatment in septated empyema where surgical options are not easily available or cost-effective especially in resource limited settings.
KeywordsEmpyema Pediatric Fibrinolytics Hospital stay VATS
The authors would like to thank Dr. T.P Yadav for his unconditional support and encouragement.
SA was involved in study design, carrying out the study, literature search and drafting of the manuscript. DN was involved in study design and critically reviewed the manuscript for the intellectual content. NB, KS, PN, SL were involved in carrying out the study. All authors have seen and approved the final draft. DN will act as guarantor for this paper.
Compliance with Ethical Standards
Institutional Ethical Clearance no.: IEC/PGIMER/RMLH449/2018.
Conflict of Interest
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