Eficacia y seguridad de la instilación precoz de estreptoquinasa intrapleural en el tratamiento del empiema paraneumónico complicado en niños

Gustavo Giachetto; Maite Arana; Martín Andruskevicius; María Cecilia Garat; María Catalina Pinchak; Gabriel Giannini; César Castillo; María Catalina Pírez

Authors

Gustavo Giachetto Universidad de la República, Facultad de Medicina, Farmacología y Terapéutica, Profesor Agregado. Clínica Pediátrica, Profesor Agregado
Maite Arana Universidad de la República, Facultad de Medicina, Pediatría, Residente
Martín Andruskevicius Universidad de la República, Facultad de Medicina, Farmacología y Terapéutica, Asistente
María Cecilia Garat Universidad de la República, Facultad de Medicina, Pediatría, Ex - Residente
María Catalina Pinchak Universidad de la República, Facultad de Medicina, Clínica Pediátrica, Profesora Adjunta
Gabriel Giannini Universidad de la República, Facultad de Medicina, Clínica Quirúrgica Pediátrica, Profesor Adjunto
César Castillo Universidad de la República, Facultad de Medicina, Imagenología, Profesor Adjunto
María Catalina Pírez Universidad de la República, Facultad de Medicina, Clínica Pediátrica, Profesora

Keywords:

STREPTOKINASE, PLEURAL EMPIEME, BACTERIAL PNEUMONIA

Abstract

Introduction: in January 2005, a protocol was implemented at the Pereira Rossell Hopital Centre, for the administration of intrapleural streptokinase (STK) as an alternative to surgical treatment of complicated empyema. Intrapleural STK, when administered in the first eight days subsequent to the placing of the drainage diminished the duration of thoracic drainage, the need for thoracotomy and a prolonged stay in hospital. In 2007, the initial protocol was modified. Thorax X-rays examinations or surgery findings began to be used for the diagnosis of complicated empyema, and STK instillation started to be indicated 12 to 36 hours after thoracic drainage.
Objective: to describe results of early intrapleural instillation of streptokinase in children hospitalized with complicated parapneumonic empyema, and to compare them to the results obtained after instillation during the first eight days subsequent to the placement of thoracic drainage.
Method: children with complicated parapneumonic empyema that were hospitalized from April 1, 2005 through September 30, 2007 were included in the study. They were divided into two cohorts. Historical: children hospitalized from April 1, 2005 and August 1, 2006, when diagnosis of complicated empyema was made according to clinical and ecographic criteria, who received intrapleural STK during the first eight days subsequent to the placement of thoracic drainage. Prospective: children hospitalized from March 1, 2007 and September 30, 2007, diagnosed and treated according to the new protocol. Evolution was compared through the following variables: duration of thoracic drainage, complications, need for thoracotomy, duration of hospital stay and death.
Results: both groups were comparable. Duration of hospital stay and thoracic drainage were lower in children treated with early intrapleural STK (p<0,05). Two children required thoracotomy, one in each cohort group. The number and type of complications was similar in both groups. None of the patients included in the study died.
Conclusions: early intrapleural instillation of STK constitutes a therapeutic alternative in the treatment of children with complicated parapneumonic empyema.

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