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. 2012 Mar;14(3):157-61.

Streptokinase fibrinolysis protocol: the advantages of a non-operative treatment for stage II pediatric empyema patients

Dan Levy Faber  1 , Lael Anson Best, Michael Orlovsky, Moshe Lapidot, Rony-Reuven Nir, Ran Kremer
Affiliations
  • PMID: 22675854

Streptokinase fibrinolysis protocol: the advantages of a non-operative treatment for stage II pediatric empyema patients

Dan Levy Faber et al. Isr Med Assoc J. 2012 Mar.

Abstract

Background: Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established.

Objectives: To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration.

Methods: We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009. Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainage

Results: Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, p = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P= 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs.11.70 +/- 5.74 days, P= 0.301).

Conclusions: Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.

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