Study of empyema and intrapleural streptokinase in management of paediatric empyema in resource limited settings
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 6, Pages 2179-2187
In empyema, white blood cells migrate to infected pleural space causing release of fibrinogen and its conversion to fibrin, which causes tissue surfaces to adhere and this will trap micro-organisms and prevent host defence mechanisms and antibiotics from reaching the site of infection. ICTD with antibiotics remains the cornerstone in management of pediatric empyema. But ICTD is hampered by presence of either thick pus which tends to block tube or fibrin deposition causing multiple loculations that cannot be drained by single chest tube. Decision for insertion of ICD was taken depending upon clinical condition of the patient, radiological and laboratory evidence. Single dose of Inj. Streptokinase, 15,000 IU/kg body wt. was dissolved in 100ml normal saline and instilled in pleural cavity through ICD over a period of 1 hour and tube was clamped for 4 hours. Patient was asked to frequently change position, so that Streptokinase could thoroughly spread in pleural cavity. 25/27 (92.5%) in ICD group had good lung expansion on follow-up. Two had persistent collapse who improved further on physiotherapy. All patients in ICD with SK group had good lung expansion.
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