Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children.
Recombinant human deoxyribonuclease I (dornase alfa) is currently used as an inhaled mucoactive agent in the treatment of cystic fibrosis. In a randomized, placebo-controlled, double-blind clinical study in 100 infants, we investigated whether the therapeutic use of dornase alfa can be extended to ventilated, fluid-restricted children to reduce reintubation rate, ventilation duration, pediatric intensive care unit (PICU) stay, and ventilation complications. While reintubation rates were similar for dornase alfa 7% vs. placebo 9% (odds ratio, 0.77; confidence interval, 0.11-4.9), the incidence of atelectasis (6 vs. 17, respectively; P-value 0.051), median ventilation time (2.2 vs. 3.4 days, respectively; P-value 0.043), median length of PICU stay (7 vs. 8 days, respectively; P-value 0.051), and mean costs (4,830 vs. 6,320, respectively) were lower in the dornase alfa group. No adverse effects were observed, even in critically ill patients. We found that dornase alfa was beneficial and safe. Our findings also indicate that dornase alfa is possibly of value from the first day of mechanical ventilation onward, particularly when longer ventilation (>3 days) is expected in fluid-restricted children after cardiac surgery.
Riethmueller
Joachim
J
Department of Pediatrics, University Children's Hospital, Tübingen, Germany. joachim.riethmueller@med.uni-tuebingen.de
Borth-Bruhns
Thomas
T
Kumpf
Matthias
M
Vonthein
Reinhard
R
Wiskirchen
Jakub
J
Stern
Martin
M
Hofbeck
Michael
M
Baden
Winfried
W
D000280:Administration, Inhalation; D003850:Deoxyribonuclease I / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000191:economics; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012121:Respiration, Artificial; D013997:Time Factors
D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I