[Intrapleural streptokinase in the treatment of complicated parapneumonic empyema]. / Instilación intrapleural de estreptoquinasa en el tratamiento del empiema paraneumónico complicado.

INTRODUCTION: Parapneumonic empyema is a frequent cause of admission in the Pediatric Hospital of the Pereira Rossell Hospital Center. In January 2005, we implemented a treatment protocol that included intrapleural streptokinase (STK) for children with complicated parapneumonic empyema as an alternative to surgery. OBJECTIVES: To describe the results of intrapleural STK in the treatment of hospitalized children with complicated parapneumonic empyema and to compare these results with those of early thoracotomy. PATIENTS AND METHODS: Children with complicated parapneumonic empyema admitted between January 1st 2004 and October 1st 2005 were included. The children were divided into two groups: a historical group, composed of children hospitalized between January 1st and December 31st 2004, treated with conventional thoracotomy before day 8 of chest drain placement and a prospective group, composed of children hospitalized between January 1st and October 1st 2005, treated with intrapleural STK before day 8 of chest drain placement. The variables used to compare outcome and treatment complications were duration of chest tube drainage after the treatment procedure, complications, re-admission, length of hospital stay, and death. RESULTS: The results in both groups were similar. Length of hospital stay showed no significant differences. Duration of chest tube drainage after intrapleural STK was significantly shorter than after thoracotomy (p < 0.001). In the thoracotomy group a significantly higher proportion of patients required partial atypical pneumonectomy (p = 0.051). There were no deaths. CONCLUSIONS: Intrapleural STK is a valid alternative for the treatment of children with complicated parapneumonic empyema.

Instilación intrapleural de estreptoquinasa en el tratamiento del empiema paraneumónico complicado / Intrapleural streptokinase in the treatment of complicated parapneumonic empyema

Introducción. En el Hospital Pediátrico del Centro Hospitalario Pereira Rossell el empiema paraneumónico constituye un motivo de hospitalización frecuente. En enero de 2005 se implementó un protocolo de tratamiento del empiema complicado que incluía la instilación de estreptoquinasa intrapleural como alternativa del tratamiento quirúrgico. Objetivos. Describir los resultados de la instilación de estreptoquinasa intrapleural en niños hospitalizados con empiema paraneumónico complicado y compararlos con los resultados de la toracotomía precoz. Pacientes y métodos. Se incluyeron los niños con empiema paraneumónico complicado que ingresaron entre el 1 de enero de 2004 y el 1 de octubre de 2005. Se dividieron en dos cohortes: Histórica, niños hospitalizados entre el 1 de enero y el 31 de diciembre de 2004, tratados con toracotomía convencional antes de los 8 días de colocado el drenaje de tórax; Prospectiva, niños hospitalizados entre el 1 de enero y el 1 de octubre de 2005, tratados con estreptoquinasa intrapleural antes de los 8 días de colocado el drenaje de tórax. Se comparó la evolución y complicaciones del tratamiento mediante las siguientes variables: duración del drenaje posprocedimiento, complicaciones, reingresos, duración de la estancia hospitalaria y muerte. Resultados. Ambos grupos fueron comparables. La estancia hospitalaria no mostró diferencias significativas. La duración del drenaje de tórax después de la instilación de estreptoquinasa intrapleural fue significativamente menor que después de la toracotomía (p < 0,001). En el grupo tratado con toracotomía una proporción mayor de pacientes requirió neumonectomía parcial atípica (p = 0,051). Ninguno de los pacientes incluidos en el estudio falleció. Conclusiones. La instilación de estreptoquinasa intrapleural es una alternativa válida para el tratamiento de niños con empiema paraneumónico complicado

Introduction. Parapneumonic empyema is a frequent cause of admission in the Pediatric Hospital of the Pereira Rossell Hospital Center. In January 2005, we implemented a treatment protocol that included intrapleural streptokinase (STK) for children with complicated parapneumonic empyema as an alternative to surgery. Objectives. To describe the results of intrapleural STK in the treatment of hospitalized children with complicated parapneumonic empyema and to compare these results with those of early thoracotomy. Patients and methods. Children with complicated parapneumonic empyema admitted between January 1st 2004 and October 1st 2005 were included. The children were divided into two groups: a historical group, composed of children hospitalized between January 1st and December 31st 2004, treated with conventional thoracotomy before day 8 of chest drain placement and a prospective group, composed of children hospitalized between January 1st and October 1st 2005, treated with intrapleural STK before day 8 of chest drain placement. The variables used to compare outcome and treatment complications were duration of chest tube drainage after the treatment procedure, complications, re-admission, length of hospital stay, and death. Results. The results in both groups were similar. Length of hospital stay showed no significant differences. Duration of chest tube drainage after intrapleural STK was significantly shorter than after thoracotomy (p < 0.001). In the thoracotomy group a significantly higher proportion of patients required partial atypical pneumonectomy (p = 0.051). There were no deaths. Conclusions. Intrapleural STK is a valid alternative for the treatment of children with complicated parapneumonic empyema