title: Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children.
abstract: 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.
authors.affiliation: Department of Pediatrics, University Children's Hospital, Tübingen, Germany. joachim.riethmueller@med.uni-tuebingen.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Riethmueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Borth-Bruhns
authors.forename: Matthias
authors.initials: M
authors.lastname: Kumpf
authors.forename: Reinhard
authors.initials: R
authors.lastname: Vonthein
authors.forename: Jakub
authors.initials: J
authors.lastname: Wiskirchen
authors.forename: Martin
authors.initials: M
authors.lastname: Stern
authors.forename: Michael
authors.initials: M
authors.lastname: Hofbeck
authors.forename: Winfried
authors.initials: W
authors.lastname: Baden
mesh_terms: 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
chemical_list: D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I