Recombinant human deoxyribonuclease improves atelectasis in mechanically ventilated children with cardiac disease

Abstract

Objective: To investigate whether a mucolytic agent, recombinant human deoxyribonuclease (rhDNase), improves atelectasis in children with cardiac illness requiring mechanical ventilation.

Design: 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.

Figures

Figure 1

Demonstrates significant difference from baseline chest radiographic atelectasis scores when comparing administration of either p value= < 0.05), 5–10 rhDNase doses (p value= < 0.01) doses or 10–15 rhDNase doses (p value= < 0.05) for all lung fields combined. This was also significant for only left lower lobe atelectasis when comparing the baseline chest radiographic atelectasis scores to the 5–10 rhDNase doses administered. *: p

Figure 2

Demonstrates that rhDNase was more effective in those patients who had > few polymorphonuclear neutrophils present in their pre-therapy trachea aspirate (p value= 0.0008). *: p

Figure 3

Shows that rhDNase is more effective in those patients with the presence of bacteria in their pre-therapy tracheal aspirate (p value= 0.007). *: p

Figure 4

Shows that rhDNase is more effective in those patients with the presence of bacteria and/ or > few polymorphonuclear neutrophils in their pre-therapy tracheal aspirate (p value= 0.0041) *: p