Abstract
To assess the impact of intrapleural urokinase and small tube thoracostomy on the management of childhood empyema thoracis. The study population included 38 children presenting consecutively to a regional surgical unit with empyema thoracis from January 2001 to December 2003. Children with malignancy, immunodeficiency and complex intercurrent illness were excluded. Primary outcome variables were the need for second intervention and duration of stay, with other variables including duration of antibiotics, serial CRP and amelioration of pyrexia. Interventions were: tube thoracostomy (16–20 Fr) alone (n = 2), tube thoracostomy (6–10 Fr) + urokinase (n = 17), thoracoscopy (tube: 20–24 Fr) (n = 9), thoracotomy (tube: 16–24 Fr) (n = 10). There were no differences in age, weight or length of prodromal symptoms, between treatment groups. There were no differences in primary outcome variables, although no child undergoing thoracotomy required further intervention. The duration of intravenous antibiotics was similar in all groups. Amelioration of pyrexia was more rapid in children undergoing thoracotomy. There were no differences seen with regard to decline in CRP level. Small tube thoracostomy and intrapleural urokinase had a similar outcome to more invasive therapies such as thoracotomy or thoracoscopy thereby supporting the evidence base for urokinase and tube drainage as first line intervention.
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Shankar KR, Kenny SE, Okoye BO, Carty HM, Lloyd DA, Losty PD (2000) Evolving experience in the management of empyema thoracis. Acta Paediatr 89(4):417–420
Spencer D (2003) Empyema thoracis: not time to put down the knife. Arch Dis Child 88(10):842–843
Silen ML, Weber TR (1995) Thoracoscopic debridement of loculated empyema thoracis in children. Ann Thorac Surg 59(5):1166–1168
Rothenberg SS, Chang JH (1997) Thoracoscopic decortication in infants and children. Surg Endosc 11(2):93–94
Merry CM, Bufo AJ, Shah RS, Schropp KP, Lobe TE (1999) Early definitive intervention by thoracoscopy in pediatric empyema. J Pediatr Surg 34(1):178–180; discussion 180–181
Stovroff M, Teague G, Heiss KF, Parker P, Ricketts RR (1995) Thoracoscopy in the management of pediatric empyema. J Pediatr Surg 30(8):1211–1215
Kern JA, Rodgers BM (1993) Thoracoscopy in the management of empyema in children. J Pediatr Surg 28(9):1128–1132
Robinson LA, Moulton AL, Fleming WH, Alonso A, Galbraith TA (1994) Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas. Annal Thorac Surg 57(4):803–813; discussion 813–814
Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM (2002) Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 57(4):343–347
Mangete ED, Kombo BB, Legg-Jack TE (1993) Thoracic empyema: a study of 56 patients. Arch Dis Child 69(5):587–588
Hoff SJ, Neblett WW III, Heller RM, Pietsch JB, Holcomb GW Jr, Sheller JR et al (1989) Postpneumonic empyema in childhood: selecting appropriate therapy. J Pediatr Surg 24(7):659–663; discussion 663–664
Alp M, Dogan R, Ucanok K, Kaya S, Unlu M, Moldibi B, et al (1988) Surgical treatment of childhood pleural empyema. Thorac Cardiovasc Surg 36(6):361–364
Mayo P, Saha SP, McElvein RB (1982) Acute empyema in children treated by open thoracotomy and decortication. Ann Thorac Surg 34(4):401–407
Kosloske AM, Cushing AH, Shuck JM (1980) Early decortication for anaerobic empyema in children. J Pediatr Surg 15(4):422–426
Raffensperger JG, Luck SR, Shkolnik A, Ricketts RR (1982) Mini-thoracotomy and chest tube insertion for children with empyema. J Thorac Cardiovasc Surg 84(4):497–504
Krishnan S, Amin N, Dozor AJ, Stringel G (1997) Urokinase in the management of complicated parapneumonic effusions in children. Chest 112(6):1579–1583
Rosen H, Nadkarni V, Theroux M, Padman R, Klein J (1993) Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest 103(4):1190–1193
Rees JHM, Spencer DA, Parikh D, Weller P (1997) Increase in the incidence of childhood empyema in the West Midlands, UK. Lancet 349:402
Gates RL, Caniano DA, Hayes JR, Arca MJ (2004) Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg 39(3):381–386
Smith B, Darzins P, Quinn M, Heller R (1992) Modern methods of searching the medical literature. Med J Aust 157:603–611
Ozcelik C, Inci I, Nizam O, Onat S (2003) Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas. Ann Thorac Surg 76(6):1849–1853; discussion 1853
Kornecki A, Sivan Y (1997) Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg 32(10):1473–1475
Chang YT, Dai ZK, Kao EL, Chou SH, Huang MF (2005) Thoracoscopic decortication: first line therapy for pediatric empyema. Eur Surg Res 37(1):18–21
Hawkins JA, Scaife ES, Hillman ND, Feola GP (2004) Current treatment of pediatric empyema. Semin Thorac Cardiovasc Surg 16(3):196–200s
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Khalil, B.A., Corbett, P.A., Jones, M.O. et al. Less is best? The impact of urokinase as the first line management of empyema thoracis. Pediatr Surg Int 23, 129–133 (2007). https://doi.org/10.1007/s00383-006-1806-5
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DOI: https://doi.org/10.1007/s00383-006-1806-5