Plastic bronchitis occurring late after the Fontan procedure: Treatment with aerosolized urokinase

Objective: To describe the use of aerosolized urokinase in a patient with plastic bronchitis after a Fontan procedure. Design: Case report. Setting: Pediatric intensive care unit in a university-affiliated children's hospital. Patients: Report of one patient with acute respiratory failure secondary to plastic bronchitis. Interventions.. Aerosolized urokinase, multiple bronchoscopies, corticosteroids, mucolytics, bronchadilators, and atrial pacing. Measurements and Main Results: Airway obstruction secondary to recurring casts improved with the treatments. Histologic analysis of the casts demonstrated less fibrin after treatments with aerosolized urokinase. No adverse events were noted. Conclusions: The addition of aerosolized urokinase to this patient's treatment regimen helped to resolve life-threatening airway obstruction secondary to fibrin casts.