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.
