Randomised trial of intrapleural urokinase in the treatment of childhood empyema
A H Thomson, J Hull, M R Kumar, C Wallis, I M Balfour Lynn, A H Thomson, J Hull, M R Kumar, C Wallis, I M Balfour Lynn
Abstract
Background: The role of intrapleural fibrinolytic agents in the treatment of childhood empyema has not been established. A randomised double blind placebo controlled trial of intrapleural urokinase was performed in children with parapneumonic empyema.
Methods: Sixty children (median age 3.3 years) were recruited from 10 centres and randomised to receive either intrapleural urokinase 40 000 units in 40 ml or saline 12 hourly for 3 days. The primary outcome measure was length of hospital stay after entry to the trial.
Results: Treatment with urokinase resulted in a significantly shorter hospital stay (7.4 v 9.5 days; ratio of geometric means 1.28, CI 1.16 to 1.41 p=0.027). A post hoc analysis showed that the use of small percutaneous drains was also associated with shorter hospital stay. Children treated with a combination of urokinase and a small drain had the shortest stay (6.0 days, CI 4.6 to 7.8).
Conclusion: Intrapleural urokinase is effective in treating empyema in children and significantly shortens hospital stay.
References
- Chest. 1993 Apr;103(4):1190-3
- Am J Respir Crit Care Med. 1998 Jan;157(1):328-30
- Chest. 2000 Jun;117(6):1728-33
- Pediatr Infect Dis J. 1993 Nov;12(11):958-9
- Clin Radiol. 2000 Jul;55(7):542-7
- Acta Paediatr. 2000 Apr;89(4):417-20
- Lancet. 1997 Feb 8;349(9049):402
- J Pediatr Surg. 1994 Dec;29(12):1539-40
- Lung. 2000;178(1):13-8
- J Pediatr Surg. 1997 Jun;32(6):870-2
- J Paediatr Child Health. 2000 Aug;36(4):375-7
- Eur Respir J. 1997 Oct;10(10):2411-8
- J Clin Invest. 1949 Jan;28(1):173-90
- Thorax. 1997 May;52(5):416-21
- Am J Respir Crit Care Med. 1999 Jan;159(1):37-42
- Arch Dis Child. 1998 Dec;79(6):510-3
- Eur Radiol. 2000;10(3):495-9
- Eur Respir J. 1997 Jan;10(1):219-25
- J Pediatr Surg. 1997 Oct;32(10):1473-5
- Pediatr Infect Dis. 1984 Nov-Dec;3(6):578-91
- AJR Am J Roentgenol. 1993 Jan;160(1):165-9
- Chest. 2000 Jul;118(1):24-7
- Am J Respir Crit Care Med. 1997 Jan;155(1):291-5
- Chest. 1997 Feb;111(2):275-9
- Pediatr Pulmonol. 2000 Jun;29(6):438-42
Source: PubMed