Effect of Direct Endotracheal Administration of Dornase alfa on Atelectasis in Children on Mechanical Ventilation
Abstract
Introduction and Objective. Dornase alfa (DA) is a recombinant human deoxyribonuclease I that cleaves extracellular long-chain DNA and shown to have mucolytic properties. DA has been effective for treatment of patients with cystic fibrosis, but its role in non-cystic fibrosis patients with atelectasis is unknown. We hypothesized that direct endotracheal instillation of DA in mechanically ventilated non-cystic fibrosis children improves atelectasis. Methods. After IRB approval, we retrospectively analyzed all mechanically ventilated non-cystic fibrosis patients who received DA via direct endotracheal instillation for atelectasis at Nicklaus Children’s PICU from 2017 to 2022. We excluded those who required ECMO support. Serial chest X-rays were reviewed for the presence and extent of atelectasis. Radiologic Atelectasis Score (RAS: max score-12) was used to assess the severity and comparison (from baseline [Day 0] to Day 1, Day 2, Day 3, and Day 7) of atelectasis. Cohen’s kappa for interrater reliability (IRR), Friedman test for repeated data analysis, Chi-square, and Mann Whitney U test for binary data analyses were used. Frequency (%) and median with IQR are used for descriptive statistics. Results. A total of 37 children (17 neonates) were included in the study. DA was started on day 5 in neonates and day 17 in non-neonates (p=0.012) after admission. DA was given for a median of 1 (1-6) days at a frequency of 2 (1-2) per day. The baseline RAS was 8 (6-10). RAS improvement was seen by >1 point in 47% and 36% by >2 points in 36% on Day 7. Neonates were more likely to show RAS improvement (p=0.047). Friedman test showed significant improvement in all patients (p=0.047) and in neonates (p=0.021) but not in the non-neonate subgroup (p=328). Conclusions-Implications. In this observational study, direct endotracheal instillation of Dornase alfa is associated with improvement in pulmonary atelectasis in neonates but not in non-neonates. This demonstrates that there is utility for the use of DA in reducing the presence of persistent atelectasis in neonate non-cystic fibrosis patients.
Abstract Category
30. Other
Secondary Abstract Category
26. Pediatrics
Keywords
Dornase Alfa, Atelectasis, Pediatric, Mechanically Ventilated
Presentation Type
Poster Presentation
Effect of Direct Endotracheal Administration of Dornase alfa on Atelectasis in Children on Mechanical Ventilation
Introduction and Objective. Dornase alfa (DA) is a recombinant human deoxyribonuclease I that cleaves extracellular long-chain DNA and shown to have mucolytic properties. DA has been effective for treatment of patients with cystic fibrosis, but its role in non-cystic fibrosis patients with atelectasis is unknown. We hypothesized that direct endotracheal instillation of DA in mechanically ventilated non-cystic fibrosis children improves atelectasis. Methods. After IRB approval, we retrospectively analyzed all mechanically ventilated non-cystic fibrosis patients who received DA via direct endotracheal instillation for atelectasis at Nicklaus Children’s PICU from 2017 to 2022. We excluded those who required ECMO support. Serial chest X-rays were reviewed for the presence and extent of atelectasis. Radiologic Atelectasis Score (RAS: max score-12) was used to assess the severity and comparison (from baseline [Day 0] to Day 1, Day 2, Day 3, and Day 7) of atelectasis. Cohen’s kappa for interrater reliability (IRR), Friedman test for repeated data analysis, Chi-square, and Mann Whitney U test for binary data analyses were used. Frequency (%) and median with IQR are used for descriptive statistics. Results. A total of 37 children (17 neonates) were included in the study. DA was started on day 5 in neonates and day 17 in non-neonates (p=0.012) after admission. DA was given for a median of 1 (1-6) days at a frequency of 2 (1-2) per day. The baseline RAS was 8 (6-10). RAS improvement was seen by >1 point in 47% and 36% by >2 points in 36% on Day 7. Neonates were more likely to show RAS improvement (p=0.047). Friedman test showed significant improvement in all patients (p=0.047) and in neonates (p=0.021) but not in the non-neonate subgroup (p=328). Conclusions-Implications. In this observational study, direct endotracheal instillation of Dornase alfa is associated with improvement in pulmonary atelectasis in neonates but not in non-neonates. This demonstrates that there is utility for the use of DA in reducing the presence of persistent atelectasis in neonate non-cystic fibrosis patients.