Retrospective analysis of large-dose intrapleural alteplase for complicated @entity4806 @entity1143 and XXXX .

@entity1143 @entity1 @entity26 @entity3509 @entity4806 @entity158 @entity456
OBJECTIVES: Medical treatment of complicated @entity1143 or @entity3509 in @entity4806 patients includes antibiotics and @entity456 . Intrapleural fibrinolysis may facilitate @entity456 ; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in @entity4806 @entity1 . Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy. METHODS: All @entity1 with parapneumonic effusions treated with intrapleural alteplase between June 2003 and December 2011 were reviewed retrospectively. Efficacy was assessed by comparing chest tube output, in mL/hr and mL/kg/hr, for 24 hours before and after the first dose of alteplase. Additional efficacy outcomes included duration of in situ chest tubes, a need for surgical intervention for @entity1143 , and length of hospital stay. Safety was assessed by frequency and severity of adverse events. Non-responders and responders were compared based on demographic and disease characteristics. Responders were defined as @entity1 who did not require surgical intervention after intrapleural alteplase therapy. RESULTS: Seventy-three @entity1 , aged 0.5 to 22.5 years, received intrapleural alteplase to facilitate @entity456 . Median alteplase dose was 7 mg (range, 3 to 10 mg; median 0.38 mg/kg). Chest tube output increased from 10.7 to 24.2 mL/hr (p = 0.006), and median length of hospital stay was 9 days. Eighty-four percent of @entity1 were responders. The most common adverse events were @entity158 (20.5%) and @entity26 desaturation greater than 10% from baseline (16.4%). High-flow nasal cannula was the most common intervention for @entity26 desaturation to 80% to 90%. Nine @entity1 (12%) required a blood transfusion during the study. CONCLUSION: Large-dose intrapleural alteplase is effective in facilitating @entity456 in @entity4806 @entity1 with complicated @entity1143 or @entity3509 . Common adverse effects include @entity158 and @entity26 desaturation. The potential for bleeding warrants clinical monitoring.
