title: Dornase alpha compared to hypertonic saline for lung atelectasis in critically ill patients.
abstract: BACKGROUND
  Despite the lack of randomized trials, nebulized Dornase alpha and hypertonic saline are used empirically to treat atelectasis in mechanically ventilated patients. Our objective was to determine the clinical and radiological efficacy of these medications as an adjunct to standard therapy in critically ill patients.
  
  
  METHODS
  Mechanically ventilated patients with new onset (<48 h) lobar or multilobar atelectasis were randomized into three groups: nebulized Dornase alpha, hypertonic (7%) saline or normal saline every 12 h. All patients received standard therapy, including chest percussion therapy, kinetic therapy, and bronchodilators. The primary endpoint was the change in the daily chest X-ray atelectasis score.
  
  
  RESULTS
  A total of 33 patients met the inclusion criteria and were randomized equally into the three groups. Patients in the Dornase alpha group showed a reduction of 2.18±1.33 points in the CXR score from baseline to day 7, whereas patients in the normal saline group had a reduction of 1.00±1.79 points, and patients in the hypertonic saline group showed a score reduction of 1.09±1.51 points. Pairwise comparison of the mean change of the CXR score showed no statistical difference between hypertonic saline, normal saline, and dornase alpha. Airway pressures as well as oxygenation, expressed as PaO(2)/F(I)O(2) and time to extubation also were similar among groups. During the study period the rate of extubation was 54% (6/11), 45% (5/11), and 63% (7/11) in the normal saline, hypertonic saline, and Dornase alpha groups, respectively (p=0.09). No treatment related complications were observed.
  
  
  CONCLUSIONS
  There was no significant improvement in the chest X-ray atelectasis score in mechanically ventilated patients with new onset atelectasis who were nebulized with Dornase alpha twice a day. Hypertonic saline was no more effective than normal saline in this population. Larger randomized control trials are needed to confirm our results.
authors.affiliation: Pulmonary/Critical Care Medicine, The Oklahoma City VA Medical Center and the University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. houssein-youness@ouhsc.edu
authors.forename: Houssein A
authors.initials: HA
authors.lastname: Youness
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mathews
authors.forename: Marwan K
authors.initials: MK
authors.lastname: Elya
authors.forename: Gary T
authors.initials: GT
authors.lastname: Kinasewitz
authors.forename: Jean I
authors.initials: JI
authors.lastname: Keddissi
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D003850:Deoxyribonuclease I / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; 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; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D003850:Deoxyribonuclease I; C568813:dornase alfa; D010100:Oxygen