Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus.
OBJECTIVE
To report the dramatic resolution of unilateral mucus plugging and atelectasis in a mechanically ventilated child with refractory status asthmaticus after intratracheal recombinant human DNase (rhDNase) therapy.


METHODS
Case report.


METHODS
Critical care unit.


METHODS
A 7-yr-old boy with status asthmaticus, severe respiratory failure and barotrauma unresponsive to conventional therapy. Fiberoptic bronchoscopy confirmed widespread mucus impaction of the subsegmental bronchi of the left lung without response to bronchoscopic lavage.


METHODS
Two 10-mg doses of intratracheal rhDNase were administered 8 hrs apart.


RESULTS
The left-sided atelectasis resolved 3 hrs after the first dose of rhDNase. Improvements in gas exchange and tidal volumes were sustained and particularly noticeable after the second dose. The patient was successfully extubated 26 hrs after receiving the rhDNase treatment without any adverse effects.


CONCLUSIONS
rhDNase should be considered as a potential therapy for refractory mucus plugging and atelectasis in intubated patients with status asthmaticus.
Durward
A
A
Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto.
Forte
V
V
Shemie
S D
SD
D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D002648:Child; D003850:Deoxyribonuclease I / Q000494:pharmacology / Q000627:therapeutic use*; D005100:Expectorants / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D009093:Mucus; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011859:Radiography; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects*; D013224:Status Asthmaticus / Q000628:therapy*; D013990:Tidal Volume / Q000187:drug effects; D013997:Time Factors
D005100:Expectorants; D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I