Plastic bronchitis occurring late after the Fontan procedure: treatment with aerosolized urokinase

Abstract

Objective: To describe the use of aerosolized urokinase in a patient with plastic bronchitis after a Fontan procedure.

Design: Case report.

Setting: Pediatric intensive care unit in a university-affiliated children's hospital.

Patients: Report of one patient with acute respiratory failure secondary to plastic bronchitis.

Interventions: Aerosolized urokinase, multiple bronchoscopies, corticosteroids, mucolytics, bronchodilators, and atrial pacing.

Measurements and main results: Airway obstruction secondary to recurring casts improved with the treatments. Histologic analysis of the casts demonstrated less fibrin after treatments with aerosolized urokinase. No adverse events were noted.

Conclusions: The addition of aerosolized urokinase to this patient's treatment regimen helped to resolve life-threatening airway obstruction secondary to fibrin casts.