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Utilização de Alteplase no tratamento de empiema em pediatria : experiência de um centro terciário
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Introdução: A pneumonia complicada de derrame pleural e empiema tem apresentado uma incidência crescente ao longo dos anos em idade pediátrica. Perante a evidência científica que suporta o uso de terapêutica fibrinolítica intrapleural no tratamento destas patologias em idade adulta, a mesma técnica tem sido crescentemente utilizada em crianças. Com este trabalho, esperamos adicionar informação relevante sobre a utilidade e perfil de segurança da respetiva abordagem terapêutica e inferir a sua taxa de eficácia face a técnicas cirúrgicas. Metodologia: Foi realizado um estudo observacional retrospetivo, incluindo todas as crianças internadas na UCIPed do HSM-CHULN, no período de 1/01/2014 a 31/12/2021, com o diagnóstico de derrame pleural parapneumónico, sujeitos a terapêutica com fibrinólise intrapleural. Resultados: Foram admitidas 83 crianças, cuja idade média é de 4,9 ± 4,4 anos, e maioritariamente do sexo masculino (57,8%). A duração de internamento na UCIPed teve uma mediana de 5 ± 3 dias. O sintoma mais prevalente foi a febre, em 97,6% das crianças. Foi administrado uma mediana de 6 ± 5 doses de alteplase, com saída de uma média de 1545 ± 1220 mL de LP, em que o agente mais frequentemente identificado foi o Streptococcus pneumoniae, serotipo 3. Não se registaram complicações relacionadas diretamente com a técnica de fibrinólise intrapleural. Verificou-se falência terapêutica com necessidade de intervenção cirúrgica em dois casos (2,4%). Conclusões: A fibrinólise intrapleural com alteplase parece ser um método seguro e eficaz na idade pediátrica para o tratamento de primeira linha de derrame pleural parapneumónico moderado a grave e empiema não complicado, em alternativa a intervenções cirúrgicas.
Introduction: The incidence of pneumonia complicated by pleural effusion and empyema has risen throughout the years in pediatric patients. As scientific evidence has supported the use of fibrinolytic therapy in the treatment of these pathologies in adults, this technique has also been increasingly used in pediatric age. This study aims to add relevant data about the utility and safeness of this technique and to presume its efficacy rate as a therapeutic approach in comparison to surgical techniques. Methods: A retrospective observational study was conducted on children admitted into the Pediatric ICU at HSM-CHULN between 01/01/2014 and 31/12/2021 with an entry diagnosis of pleural parapneumonic effusion, subjected to intrapleural fibrinolysis. Results: A total of 83 children were admitted, from which the mean age was 4,9 ± 4,4 years, predominantly male (57,8%). The median for the hospitalization period in the Pediatric ICU was 5 ± 3 days. The most prevalent symptom was fever, reported in 97,6% of children. A median of 6 ± 5 doses of alteplase were administered, with a mean pleural fluid drainage of 1545 ± 1220 mL, in which the most frequently identified microorganism was Streptococcus pneumoniae, serotype 3. There were no record of direct complications of intrapleural fibrinolysis. Surgical intervention was required in two cases (2,4%). Conclusions: Alteplase used as an intrapleural fibrinolysis agent looks like a safe and effective technique in pediatric patients for the treatment of moderate/severe pleural parapneumonic effusion and non-complicated empyema, as an alternative to surgical intervention.
Introduction: The incidence of pneumonia complicated by pleural effusion and empyema has risen throughout the years in pediatric patients. As scientific evidence has supported the use of fibrinolytic therapy in the treatment of these pathologies in adults, this technique has also been increasingly used in pediatric age. This study aims to add relevant data about the utility and safeness of this technique and to presume its efficacy rate as a therapeutic approach in comparison to surgical techniques. Methods: A retrospective observational study was conducted on children admitted into the Pediatric ICU at HSM-CHULN between 01/01/2014 and 31/12/2021 with an entry diagnosis of pleural parapneumonic effusion, subjected to intrapleural fibrinolysis. Results: A total of 83 children were admitted, from which the mean age was 4,9 ± 4,4 years, predominantly male (57,8%). The median for the hospitalization period in the Pediatric ICU was 5 ± 3 days. The most prevalent symptom was fever, reported in 97,6% of children. A median of 6 ± 5 doses of alteplase were administered, with a mean pleural fluid drainage of 1545 ± 1220 mL, in which the most frequently identified microorganism was Streptococcus pneumoniae, serotype 3. There were no record of direct complications of intrapleural fibrinolysis. Surgical intervention was required in two cases (2,4%). Conclusions: Alteplase used as an intrapleural fibrinolysis agent looks like a safe and effective technique in pediatric patients for the treatment of moderate/severe pleural parapneumonic effusion and non-complicated empyema, as an alternative to surgical intervention.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Derrame parapneumónico Empiema Idade pediátrica Alteplase Pediatria