title: Clinical and in vitro effect of dornase alfa in mechanically ventilated pediatric non-cystic fibrosis patients with atelectases.
abstract: BACKGROUND
  At present no evidence-based medical treatment for persistent atelectasis in pediatric non-cystic fibrosis (CF) patients is available.
  
  
  METHODS
  To evaluate the use of intratracheally instilled recombinant human deoxyribonuclease (rhDNase) in intubated and ventilated pediatric patients, we performed a single-center observational study on 46 pediatric intensive care patients who had received intratracheal DNase. Patients were classified, according to radiologic findings of atelectasis (group 1) or infiltrates. As controls we examined a historical control group of 17 patients with atelectasis after cardiac surgery, who had been treated with NaCl 0.9% and matched for age and diagnosis with 21 patients from group 1 (subgroup 1a). Radiologic improvement and inflammatory markers in both serum and tracheal aspirates were measured.
  
  
  RESULTS
  In group 1, 35 patients had 51 atelectases/dystelectases episodes at baseline. 67 % of patients showed radiologic signs of improvement after 24h treatment with rhDNase. In subgroup 1a, 16 patients had complete resolution of atelectases and minimal change in dystelectases after a treatment of 24 hours rhDNase, compared with the control group of 17 patients, who had 7 atelectases and 10 dystelectases at baseline and an improvement in only 1 out of 17 (6 %) patients after 24h.
  
  
  CONCLUSIONS
  Intratracheal instillation of rhDNase is an effective adjunct to conservative therapy of atelectases in children. Further randomized controlled prospective studies are necessary.
authors.affiliation: Department of Pediatrics, University of Tuebingen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Riethmueller
authors.forename: Matthias
authors.initials: M
authors.lastname: Kumpf
authors.forename: Thomas
authors.initials: T
authors.lastname: Borth-Bruhns
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brehm
authors.forename: Jakub
authors.initials: J
authors.lastname: Wiskirchen
authors.forename: Ludger
authors.initials: L
authors.lastname: Sieverding
authors.forename: Cosima
authors.initials: C
authors.lastname: Ankele
authors.forename: Michael
authors.initials: M
authors.lastname: Hofbeck
authors.forename: Winfried
authors.initials: W
authors.lastname: Baden
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003850:Deoxyribonuclease I / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I