Yusuf M Garwan, Muath A Alsalloum, A Jill Thompson, Taylor Morrisette, Katherine H Chessman
{"title":"应用胸膜内阿替普酶治疗儿童肺旁积液:10年经验报告。","authors":"Yusuf M Garwan, Muath A Alsalloum, A Jill Thompson, Taylor Morrisette, Katherine H Chessman","doi":"10.5863/JPPT-24-00057","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.</p><p><strong>Methods: </strong>A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.</p><p><strong>Results: </strong>Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.</p><p><strong>Conclusions: </strong>Lower alteplase doses (≤2 mg) were effective for most children with PPE. Alteplase combined with primary VATS might be associated with better outcomes.</p>","PeriodicalId":37484,"journal":{"name":"Journal of Pediatric Pharmacology and Therapeutics","volume":"30 4","pages":"484-493"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351476/pdf/","citationCount":"0","resultStr":"{\"title\":\"Use of Intrapleural Alteplase in the Treatment of Parapneumonic Effusion in Children: A Report of a 10-year Experience.\",\"authors\":\"Yusuf M Garwan, Muath A Alsalloum, A Jill Thompson, Taylor Morrisette, Katherine H Chessman\",\"doi\":\"10.5863/JPPT-24-00057\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.</p><p><strong>Methods: </strong>A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.</p><p><strong>Results: </strong>Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.</p><p><strong>Conclusions: </strong>Lower alteplase doses (≤2 mg) were effective for most children with PPE. 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Use of Intrapleural Alteplase in the Treatment of Parapneumonic Effusion in Children: A Report of a 10-year Experience.
Objectives: Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.
Methods: A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.
Results: Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.
Conclusions: Lower alteplase doses (≤2 mg) were effective for most children with PPE. Alteplase combined with primary VATS might be associated with better outcomes.
期刊介绍:
The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.