Intrapleural Fibrinolysis. Solution of Heterogeneous Fibroproductive Pleural Collections withLoculation Tendencies

Overview

Infections of the lower airways are as a rule associated with complications. Pleural exudates are among themost unpleasant both for the patient and the physician. They cause significant deterioration of the clinical courseand protract treatment of the basic disease.In 1998, Plzeň, at the intensive care unit of the Paediatric Clinic, Faculty Hospital Plzeň a total of 16 patientswere treated on account of a fibroproductive pleural process of different etiology. The authors evaluated the scopeand impact of pleural collection according to their own criteria and used them to standardize the innovation of thehitherto used therapeutic strategy. They supplemented antibiotics administered by the parenteral route bycyclooxygenase inhibitor (iCOX-1) to reduce pleural exudation. Complete evacuation of pleural collection witha tendency of encapsulation was achieved reliably in five patients by means of intrapleural fibrinolysis. Theyelaborated their own method for the intrapleural administration of streptokinase (IPSK). By repeated examina-tions they tested its effectiveness and confirmed the safety of IPSK.The authors evaluated their experience and reached the conclusion that small and medium pleural collectionsare cured better and in a shorter time by conservative treatment. In major and encapsulated collections it isnecessary to use an „invasive“ therapeutic procedure with intercostal drainage combined with IPSK to obtain thesame result.The authors submit to the paediatric community a tested, reliable and safe non-surgical alternative for curingfibroproductive pleural processes in children treated at the intensive care unit.

Key words:
intrapleural fibrinolysis, IPSK, pleural collection