Urokinase is an
enzyme with a fibrinolytic effect that facilitates
pleural empyema drainage through a
chest tube. The aim of this study was to assess the risk of
pneumothorax, the need for pleural
debridement surgery, the persistence of
fever, and the number of days in hospital in a group of children with parapneumonic
pleural empyema treated with
urokinase. This was an uncontrolled retrospective study on children suffering from parapneumonic
empyema. Data collected on 17 children treated with
urokinase were compared with 11 children treated prior to the advent of
urokinase (the "historic" group). The
urokinase was instilled in the pleural cavity over a period ranging from 2-8 days, amounting to a median total dose per kilogram of
body weight of 18,556 IU (range, 7,105-40,299). Surgical treatment of the
empyema involved drainage tube placement and/or
debridement of the pleural cavity. Three children developed
pneumothorax during their
hospital stay, and one more case occurred 6 months after the child had recovered from his
empyema; there were 3 cases of
pneumothorax during the acute phase in the "historic" group (P = 0.54). Five children in the
urokinase group were debrided and 12 were only drained, as opposed to 9 and 2, respectively, in the "historic" group (P = 0.02). The overall
hospital stay was 17 days for the
urokinase group, and 24 for the "historic" group (P = 0.02). No
bleeding or other major complications were reported in the group treated with
urokinase. In conclusion,
urokinase treatment does not carry a risk of
pneumothorax, while it does reduce
hospital stay and the need for pleural
debridement.