Document Detail

Treatment of encapsulated pleural effusions in children: a prospective trial.
MedLine Citation:
PMID:  19919636     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim of this study was to improve the efficacy of treatment of complicated pleural effusions.
METHODS: In this prospective study, 76 consecutive children (average age 5.0 +/- 4.14 years) fulfilling the required classification criteria were duly treated with chest tube placement and divided into two groups depending on the presence of encapsulated or non-encapsulated effusions. Treatment of the former group was supplemented by intrapleural fibrinolysis. The effectiveness of treatment was assessed in terms of chest tube dwell-time and total length of hospitalization. Regression analysis was performed using independent factors that were associated with these dependent factors. Value differences for P < 0.05 were considered significant.
RESULTS: The ultrasound pleural distance and lactic-dehydrogenase content in the pleural fluid was significantly associated with the length of treatment (P < 0.01). Improved response to treatment, reduced duration of hospitalization (9.2 +/- 1.9 vs 11.5 +/- 0.9; P < 0.01) and tube dwell-time (7.6 +/- 1.3 vs 9.5 +/- 0.9; P < 0.01) was achieved in the intrapleural-fibrinolysis-treated group (n= 38) compared with controls (n= 38), with virtually the same total tube output (606.1 +/- 257.5 vs 673.1 +/- 347.4; P= 0.175). All patients were completely cured. Following 104 applications of the fibrinolytic agent there was one change in coagulation parameters: hypofibrinogenemia (in 1%).
CONCLUSIONS: The authors recommend intrapleural fibrinolysis as an effective and safe alternative treatment strategy in treating encapsulated pleural effusions in children.
Jiri Kobr; Katerina Pizingerova; Lumir Sasek; Jiri Fremuth; Konrad Siala; Jaroslav Racek
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-16
Journal Detail:
Title:  Pediatrics international : official journal of the Japan Pediatric Society     Volume:  52     ISSN:  1442-200X     ISO Abbreviation:  Pediatr Int     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886002     Medline TA:  Pediatr Int     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  453-8     Citation Subset:  IM    
Department of Paediatrics-PICU, Faculty of Medicine in Pilsen and Faculty Hospital in Pilsen, Czech Republic.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Chest Tubes
Child, Preschool
Combined Modality Therapy
Drainage / methods
Empyema, Pleural / microbiology,  therapy*,  ultrasonography
Fibrinolytic Agents / administration & dosage*
Follow-Up Studies
Injections, Intralesional
Length of Stay
Logistic Models
Multivariate Analysis
Pleural Effusion / microbiology,  therapy*,  ultrasonography
Pneumonia, Bacterial / microbiology,  therapy*,  ultrasonography
Prospective Studies
Risk Assessment
Severity of Illness Index
Streptokinase / administration & dosage*
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Fibrinolytic Agents; EC 3.4.-/Streptokinase

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