Dornase Alpha Compared to Hypertonic Saline for Lung Atelectasis in Critically Ill Patients
Publication: Journal of Aerosol Medicine and Pulmonary Drug Delivery
Volume 25, Issue Number 6
Abstract
Background: Despite the lack of randomized trials, nebulized Dornase alpha and hypertonic saline are used empirically to treat atelectasis in mechanically ventilated patients. Our objective was to determine the clinical and radiological efficacy of these medications as an adjunct to standard therapy in critically ill patients.
Methods: Mechanically ventilated patients with new onset (<48 h) lobar or multilobar atelectasis were randomized into three groups: nebulized Dornase alpha, hypertonic (7%) saline or normal saline every 12 h. All patients received standard therapy, including chest percussion therapy, kinetic therapy, and bronchodilators. The primary endpoint was the change in the daily chest X-ray atelectasis score.
Results: A total of 33 patients met the inclusion criteria and were randomized equally into the three groups. Patients in the Dornase alpha group showed a reduction of 2.18±1.33 points in the CXR score from baseline to day 7, whereas patients in the normal saline group had a reduction of 1.00±1.79 points, and patients in the hypertonic saline group showed a score reduction of 1.09±1.51 points. Pairwise comparison of the mean change of the CXR score showed no statistical difference between hypertonic saline, normal saline, and dornase alpha. Airway pressures as well as oxygenation, expressed as PaO2/FIO2 and time to extubation also were similar among groups. During the study period the rate of extubation was 54% (6/11), 45% (5/11), and 63% (7/11) in the normal saline, hypertonic saline, and Dornase alpha groups, respectively (p=0.09). No treatment related complications were observed.
Conclusions: There was no significant improvement in the chest X-ray atelectasis score in mechanically ventilated patients with new onset atelectasis who were nebulized with Dornase alpha twice a day. Hypertonic saline was no more effective than normal saline in this population. Larger randomized control trials are needed to confirm our results.
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Information & Authors
Information
Published In

Journal of Aerosol Medicine and Pulmonary Drug Delivery
Volume 25 • Issue Number 6 • December 2012
Pages: 342 - 348
PubMed: 22413805
Copyright
Copyright 2012, Mary Ann Liebert, Inc.
History
Published in print: December 2012
Published online: 28 November 2012
Published ahead of print: 13 March 2012
Accepted: 22 January 2012
Received: 21 November 2011
Authors
Author Contributions
All authors were involved with the acquisition, analysis, and interpretation of data. Drs. Youness and Keddissi were involved in the conception and design of the study. Kathryn Mathews, was involved in patients' randomization and in obtaining funding. Drs. Elya and Youness were involved in patient recruitment. Dr. Youness was involved in the drafting of the manuscript. Drs. Keddissi and Kinasewitz were involved in the supervision of the study and the critical revision of the manuscript.
Author Disclosure Statement
The authors declare that no conflicting financial interests exist.
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