ISOLATED CHEST TUBE DRAINAGE VERSUS DRAINAGE COMBINED WITH INTRAPLEURAL FIBRINOLYSIS IN PEDIATRIC COMPLICATED PNEUMONIA: A RETROSPECTIVE STUDY IN A SECONDARY HOSPITAL IN CEARÁ, BRAZIL

Abstract

Introduction: Community-acquired pneumonia complicated by pleural effusion/empyema in children is associated with prolonged hospitalization and the need for invasive interventions. Intrapleural fibrinolysis has emerged as a less invasive alternative to surgery; however, its clinical benefits remain controversial. Objective: To compare clinical outcomes between isolated chest tube drainage and drainage combined with intrapleural fibrinolysis. Methods: A retrospective study was conducted in a secondary hospital in Ceará, Brazil, including children who underwent chest tube drainage with or without fibrinolytic therapy according to an institutional protocol implemented in 2023. Length of hospital stay, chest tube duration, complications, and need for surgery were evaluated. Results: Sixteen children were included, with a mean age of 55.8 months. The mean length of hospital stay was > 20 days. No statistically significant differences were identified between groups; however, a trend toward shorter hospital stay and shorter chest tube duration was observed in the fibrinolysis group. Only one patient required thoracotomy. Discussion: Despite the absence of statistical significance, the observed trend suggests a possible clinical benefit of fibrinolysis, particularly in secondary care settings, where reductions in length of stay may impact resource utilization and the need for referral to specialized surgical centers. Conclusion: Fibrinolysis appeared safe and potentially advantageous, warranting further prospective studies with greater statistical power.