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Tissue Plasminogen Activator as an Adjuvant Therapy for Pleural Empyema in Pediatric Patients

John W. Berkenbosch, MD

Pierantonio Russo, MD

Joseph D. Tobias, MD

Department of Anesthesiology, Pediatric Critical Care/Pediatric Anesthesiology, Russell and Mary Shelden Chair in Pediatric Intensive Care Medicine, Anesthesiology and Child Health, The University of Missouri, Department of Anesthesiology, 3W40H, One Hospital Drive, Columbia, MO 65212 Tobiasj{at}health.missouri.edu

The authors retrospectively review the clinical course and outcome of 6 pediatric patients, ranging in age from 2 to 13 years, who were treated with TPA for complex empyema. Efficacy was assessed by evaluating pleural fluid drainage for 6 hours prior to and subsequent to each dose of TPA, as well as by resolution of fever and length of hospital stay. The average volume drained for 6 hours before infusion of TPA was 22.5 mL ± 18.4 mL, and the average volume 6 hours after TPA therapy was 141.7 mL ± 28.3 mL, P < .0001. After initiation of TPA therapy, 5 out of 6 patients became afebrile within 48 hours. The median length of stay after initiation of TPA therapy was 6 days, with a range from 4 days to 12 days. A discussion of other current therapies for empyema, along with a comparison of these therapies to TPA regarding the costs of therapies and risk-benefit ratios, is also included.

Key Words: tissue plasminogen activator • streptokinase • urokinase • empyema • pleural effusion

Journal of Intensive Care Medicine, Vol. 19, No. 1, 44-50 (2004)
DOI: 10.1177/0885066603259942


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