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Once-Daily Intrapleural Urokinase Treatment of Complicated Parapneumonic Effusion in Pediatric Patients
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Maria Anastasia Bianchini¹, Pier Luca Ceccarelli¹, Paolo Repetto¹, Viviana Durante¹,
Diego Biondini¹, Barbara Bergamini², Alfredo Cacciari¹
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Departments of ¹Pediatric Surgery, and ²Pediatrics, Azienda Universitaria Ospedaliera Policlinico di Modena, Modena,
Italy
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In this paper, we describe our experience in the treatment of childhood
empyema using urokinase. Patients’ ages ranged from 2 to 12 years. Urokinase
(dosage: 3,100 IU/kg/day) was diluted in normal saline to produce 1000 IU/ml
(maximum dosage 100,000 IU in 100 ml of normal saline). After 2 hours,
the clamped catheters were released and connected to water-seal suction at a
negative pressure of 10 cm H2O. Pleural irrigations were continued once a day
until thoracostomy tube output decreased to less than 10 ml/day (urokinase
treatment mean duration: 11.5 days). The complete resolution of the chest
effusion was assessed on chest ultrasound scan and radiographs. None of
the patients experienced any side effects due to urokinase. It would now
seem reasonable to advocate small chest tube thoracostomy and intrapleural
urokinase as first-line treatment of pleural empyema in children, with surgery
indicated as a secondary intervention.
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