Introduction Use of chest ultrasonography as a diagnostic tool and intrapleural fibrinolytic therapy is an alternative to surgical intervention in children with severe pneumonia and parapneumonic loculated effusions.
Objectives To study complicated parapneumonic effusions using bedside chest ultrasonography (U/S) and intrapleural urokinase in our PICU.
Methods Children with pleural effusion were recruited during 2006–2009(A) and 2010–2012(B). Chest tube was inserted and intrapleural urokinase (40,000 IU/kg/dose every 12 hours) was administered. Surgical intervention was reserved for patients with necrotic pneumonia and pulmonary abscess.
Results 16 patients (age 3.8±0.7 year; males:females 9:7) were diagnosed with significant effusion. Streptococcus pneumoniae and Staphylococcus aureus were more frequently isolated. More patients in period B experienced severe necrotic pneumonia compared to A (5 vs. 0), needed urokinase (4 vs. 1), or required surgery (2 vs. 0) (p<0.04), and had prolonged length of stay (13±4 vs. 5±1 days, p<0.05). Five patients received urokinase (31%) and 2 (12.5%) required an operative intervention. Patients requiring surgical intervention had longer length of stay (21 vs. 5 or 12, p=0.005). There were no significant differences between groups regarding pleural effusion characteristics, amount of drained pleural fluid (130±1 vs. 406±76 vs.457±132 ml), and fever duration after chest tube insertion (8±8 vs. 2±1vs.10±7 days, respectively).None of the patients experienced any side effects due to urokinase; all patients discharged in good condition.
Conclusions Aggressive intrapleural fibrinolytic treatment based on bedside chest ultrasonograhy confers significant benefit in effectively treating multi-loculated pleural effusions, reserving surgical intervention for necrotic pneumonia and pulmonary abscesses.
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