Recombinant human deoxyribonuclease improves atelectasis in mechanically ventilated children with cardiac disease.
OBJECTIVE
To investigate whether a mucolytic agent, recombinant human deoxyribonuclease (rhDNase), improves atelectasis in children with cardiac illness requiring mechanical ventilation.


METHODS
A retrospective cohort study on consecutive patients receiving short-term (< or =14 days) rhDNase therapy for atelectasis in the cardiac intensive care unit from January 2005 through February 2007 was carried out. Data relating to patient characteristics, gas exchange, ventilatory parameters, and chest radiographs were collected and analyzed. The effectiveness of rhDNase therapy in the presence of neutrophils and/or bacteria in the pre-rhDNase therapy tracheal aspirates was also investigated.


RESULTS
rhDNase was effective in significantly improving established atelectasis without any major changes in gas exchange and ventilatory parameters. Therapeutic effect of rhDNase is most effective in ameliorating atelectasis in the lungs within 10 doses. rhDNase was more effective in improving chest radiographic atelectasis score in patients who had > moderate amounts of polymophonuclear neutrophils (P value = 0.0008), or bacteria (P value = 0.007) or both (P value = 0.004) present in their pre-rhDNase therapy trachea aspirate. No adverse effects were seen with rhDNase administration in the study cohort.


CONCLUSIONS
rhDNase can be safely and effectively used to improve atelectasis in mechanically ventilated children with cardiac disease especially in the presence of bacteria and/or moderate amounts of polymophonuclear neutrophils in the pre-rhDNase therapy tracheal aspirate.
Prodhan
Parthak
P
Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72202, USA. prodhanparthak@uams.edu
Greenberg
B
B
Bhutta
Adnan T
AT
Hyde
Carrie
C
Vankatesan
Ajay
A
Imamura
Michiaki
M
Jaquiss
Robert Db
RD
Dyamenahalli
Umesh
U
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003851:Deoxyribonucleases / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005100:Expectorants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology; D001261:Pulmonary Atelectasis / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012123:Pulmonary Ventilation / Q000187:drug effects; D011994:Recombinant Proteins / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D005100:Expectorants; D011994:Recombinant Proteins; D003851:Deoxyribonucleases