Elsevier

Journal of Pediatric Surgery

Volume 29, Issue 12, December 1994, Pages 1539-1540
Journal of Pediatric Surgery

Case report
Intrapleural instillation of urokinase in the treatment of loculated pleural effusions in children

https://doi.org/10.1016/0022-3468(94)90209-7Get rights and content

Abstract

The authors report on the use of intrapleural instillation of urokinase in the treatment of loculated pleural effusions in two pediatric patients. Urokinase helps to lyse fibrin by converting plasminogen to plasmin. The intrapleural instillation of urokinase is safe and effective for promoting drainage of loculated intrapleural effusions, and it proved a useful option in the treatment of persistent loculations.

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    2012, Journal of Pediatric Surgery
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    The common examples are urokinase, streptokinase and tissue plasminogen activator (tPA). Since fibrin is a predominant component of the extracellular matrix upon which septations and solid debris form, instillation of a fibrinolytic agent to liquefy pleural space disease has been shown to be effective in promoting resolution of empyema in multiple studies [39,40,44-63]. Fibrinolysis has been shown to be superior to chest tube drainage alone in retrospective and prospective studies, by both direct comparison and when used in patients who failed chest tube drainage only [44-46,50,53-55,58,61,63].

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    Although several small trials suggested that intrapleural urokinase and streptokinase could increase the amount of fluid drained and improve outcome in adults,17,18 a recent meta-analysis showed that there is not sufficient evidence to recommend the routine use of fibrinolytics,14 and a large-scale, multicenter, randomized trial (MIST1) failed to confirm any benefits of intrapleural streptokinase versus normal saline.19 The use of fibrinolytics in children with empyema has first been described by Rosen et al in 199320; several other authors have reported successful treatment of childhood empyema with instillation of either streptokinase or urokinase.7,21-23 However, streptokinase is of bacterial origin, and several undesired effects have been reported including fever, allergic reactions, and significant anti-streptokinase antibody production.19,20,24

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    At the time this study was developed and initiated, there were no published prospective trials comparing intrapleural fibrinolysis to thoracoscopic debridement for empyema. There were an abundance of data on the use of fibrinolysis in children to facilitate earlier resolution of empyema [8-23]. A review on the therapeutic options for empyema in children was published shortly before we began this study that concluded with the statement that a prospective, randomized trial comparing VATS to intrapleural fibrinolytic therapy was needed [24].

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