Research

DNase and atelectasis in non-cystic fibrosis pediatric patients

Tom Hendriks¹, Matthijs de Hoog², Maarten H Lequin³, Annick S Devos³ and Peter JFM Merkus⁴

¹Pediatrician, Catharina Hospital, Eindhoven, The Netherlands

²Pediatric Intensivist, Division of Intensive Care, Department of Pediatrics, Erasmus University and Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, The Netherlands

³Pediatric Radiologist, Division of Radiology, Department of Pediatrics, Erasmus University and Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, The Netherlands

⁴Pediatric Pulmonologist, Division of Respiratory Medicine, Department of Pediatrics, Erasmus University and Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, The Netherlands

author email corresponding author email

Critical Care 2005, 9:R351-R356doi:10.1186/cc3544

Published:	20 May 2005

See related commentary http://ccforum.com/content/9/4/341

Abstract

Introduction

No evidence based treatment is available for atelectasis. We aimed to evaluate the clinical and radiologic changes in pediatric patients who received DNase for persistent atelectasis that could not be attributed to cardiovascular causes, and who were unresponsive to treatment with inhaled bronchodilators and physiotherapy.

Methods

All non-cystic fibrosis pediatric patients who received nebulised or endotracheally instilled DNase for atelectasis between 1998 and 2002, with and without mechanical ventilation, were analysed in a retrospective descriptive study. The endpoints were the blood pCO₂, the heart rate, the respiratory rate, the FiO₂ and the chest X-ray scores before and after treatment.

Results

In 25 of 30 patients (median [range] age, 1.6 [0.1–11] years) who met inclusion criteria, paired data of at least three endpoints were available. All clinical parameters improved significantly within 2 hours (P < 0.01), except for the heart rate (P = 0.06). Chest X-ray scores improved significantly within 24 hours after DNase treatment (P < 0.001). Individual improvement was observed in 17 patients and no clinical change was observed in five patients. Temporary deterioration (n = 3) was associated with increased airway obstruction and desaturations. No other complications were observed.

Conclusion

After treatment with DNase for atelectasis of presumably infectious origin in non-cystic fibrosis pediatric patients, rapid clinical improvement was observed within 2 hours and radiologic improvement was documented within 24 hours in the large majority of children, and increased airway obstruction and ventilation–perfusion mismatch occurred in three children, possibly due to rapid mobilisation of mucus. DNase may be an effective treatment for infectious atelectasis in non-cystic fibrosis pediatric patients.