Infections of the lower airways are as a rule associated with complications. Pleural exudates are among the most unpleasant both for the patient and the physician. They cause significant deterioration of the clinical course and protract treatment of the basic disease. In 1998, Plzeň, at the intensive care unit of the Paediatric Clinic, Faculty Hospital Plzeň a total of 16 patients were treated on account of a fibroproductive pleural process of different etiology. The authors evaluated the scope and impact of pleural collection according to their own criteria and used them to standardize the innovation of the hitherto used therapeutic strategy. They supplemented antibiotics administered by the parenteral route by cyclooxygenase inhibitor (iCOX-1) to reduce pleural exudation. Complete evacuation of pleural collection with a tendency of encapsulation was achieved reliably in five patients by means of intrapleural fibrinolysis. They elaborated their own method for the intrapleural administration of streptokinase (IPSK). By repeated examina- tions they tested its effectiveness and confirmed the safety of IPSK. The authors evaluated their experience and reached the conclusion that small and medium pleural collections are cured better and in a shorter time by conservative treatment. In major and encapsulated collections it is necessary to use an „invasive“ therapeutic procedure with intercostal drainage combined with IPSK to obtain the same result. The authors submit to the paediatric community a tested, reliable and safe non-surgical alternative for curing fibroproductive pleural processes in children treated at the intensive care unit.

        Key words: intrapleural fibrinolysis, IPSK, pleural collection