The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

RECOMBINANT HUMAN DNASE IN THE MANAGEMENT OF PERSISTENT ATELECTASIS IN A VENTILATED PEDIATRIC POPULATION.

Shonola Da-Silva, Imran Sajan, Michelle De Souza. Children’s Regional Hospital @ UMDNJ/RWJ Medical School Cooper Health System, Camden NJ

Purpose: Airway obstruction & atelectasis attributable to mucus plugging is a frequent complication in ventilated pediatric ICU patients secondary to a combination of thick viscous secretions & the small caliber of the airway. The abnormal viscoelastic properties of the secretions are due to the presence of highly polymerized polyionic DNA from the nuclei of degenerating polymorphonuclear leukocytes. Treatment of the atelectasis by conventional methods such as percussion & vibration often fails & flexible bronchoscopy is technically difficult in this population. Recombinant human DNase (rhDNase, Pulmozyme) has been shown to reduce the viscosity of purulent bronchial secretion by fragmenting extracellular DNA. We present our experience with rhDNase in a ventilated pediatric population. Setting Multidisciplinary P ICU of an academic children’s hospital

Methods:
Retrospective case review. Patients were identified from the computer charge data of the hospital. All patients admitted to the PICU who received a charge for rhDNase during the period of November ‘01 to December ‘03 were reviewed. The protocol for rhDNase administration in intubated patients had been instituted a priori by the primary author. All patients had rhDNase, 2.5mg diluted in 3cc of NS instilled into the ETT, followed by manual breaths using the bag-valve-ETT. All patients were positioned in the lateral decubitus position with the atelectatic side in the dependent position. A chest x-ray was obtained before administration of the rhDNase & at 4-6 hours after the instillation. The dose of rhDNase was repeated every 12 hours until improvement was seen on x-ray.

Results: A total of 12 patients were identified by the computer charge data. 3 patients were not intubated & had the rhDNase administered by nebulization. Of these, 1 had complete resolution of the atelectasis while 2 had no significant effect. 9 patients were intubated & had the rhDNase instilled into the ETT. All 9 had complete resolution of the atelectasis with 1-4 doses of rhDNase (Table). 7 of the 9 patients had conventional management of atelectasis without resolution and thus served as their own controls. 1 patient had a bedside flexible bronchoscopy performed with only partial resolution & the atelectasis recurred within 24 h. 2 of the patients had clinical conditions that prevented aggressive CPT and had rhDNase instilled without prior attempt with CPT.

Conclusion: We believe that a therapeutic trial of rhDNase may be an option in the treatment of persistent atelectasis in ventilated children.


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