Clinical and in vitro effect of dornase alfa in mechanically ventilated pediatric non-cystic fibrosis patients with atelectases.
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.
Riethmueller
Joachim
J
Department of Pediatrics, University of Tuebingen, Germany.
Kumpf
Matthias
M
Borth-Bruhns
Thomas
T
Brehm
Wolfgang
W
Wiskirchen
Jakub
J
Sieverding
Ludger
L
Ankele
Cosima
C
Hofbeck
Michael
M
Baden
Winfried
W
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
D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I