Bronchoscopic instillation of DNase to manage refractory lobar atelectasis in a lung cancer patient

Assallum, Hussein; Song, Tian; DeLorenzo, Lawrence; Harris, Kassem

doi:10.21037/atm.2019.05.15

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…In this "uncharted" postoperative recovery situation we improvised by leaving the catheter inside the source of secretions i.e., the RUL bronchus (the remaining after the lower bilobectomy) leaving time for the infection to subside, keeping the airways and the bilobectomy bronchial stump clear and at the same time avoiding trauma to it from blind suctioning through the tracheostomy. Other authors have published such endeavors for example using DNase instillation in the airways or using double lumen endotracheal intubation for left lung atelectasis (4,5). To our knowledge this practice of leaving a catheter inside the airways for continuous suctioning is reported for the first time.…”

Section: Discussionmentioning

confidence: 95%

“…In some cases, more aggressive interventions may be needed i.e., non-invasive ventilation and direct airway suctioning (with bronchoscopy or a tracheostomy) (1,3). There are, however, rare cases in which the collapse persists, despite all the aforementioned measures, leading to the need for improvisation in an effort to avoid further surgery, which in borderline patients can be detrimental (4,5).…”

Section: Introductionmentioning

confidence: 99%

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Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report

Kouritas¹,

Ross²,

Bilyy³

et al. 2021

Ann Transl Med

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The presentation of post lung resection atelectasis can vary between simple atelectasis and total lung collapse i.e., "white -out", making its treatment demanding in many occasions. We herein present the technique of continuous suctioning of the right upper lobe (RUL) by positioning a suction catheter inside the right upper lobe bronchus (RULB) through a tracheostomy in a sedated patient. This technique was used in the case of a 70-year-old patient who underwent a complicated redo thoracotomy and right lower lobectomy for lung cancer after a previous middle lobectomy via double thoracotomy for similar pathology. He had a significant ankylosis spondylitis past medical history with bamboo spine treated with long term high doses of steroids and methotrexate. Post redo surgery he developed respiratory failure with a radiologically significant RUL collapse, i.e., a "white-out", of the operated side which was refractory to usual conservative or bronchoscopic treatment. As a last resort, and in an effort to avoid high risk pneumonectomy, the patient was sedated, and a suction catheter was left inside the RULB under direct bronchoscopic guidance. This allowed the secretions inside the airways to be cleared, giving the remaining upper lobe infection time to subside, protected the stump from infective secretions and blind suctioning and led to avoidance of a high-risk pneumonectomy. The upper lobe cleared up from its collapse and patient's discharge from high dependency unit was achieved. This described maneuver can be useful in refractory cases of atelectasis when other measures have failed, in borderline patients or in patients where further surgery is technically cumbersome.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report

Kouritas¹,

Ross²,

Bilyy³

et al. 2021

Ann Transl Med

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“…The use of Pulmozyme in patients with head and neck cancer after radiochemotherapy reduced the viscosity of oropharyngeal secretions, which increased secondary indicators of quality of life [174]. The application of Pulmozyme makes it possible to cope with lung atelectasis, which is a frequent complication of lung cancer, in a safer manner than conservative treatment (therapeutic bronchoscopy) [175]. Pulmozyme inhalation also decreased excessive NET density in lungs, which reduced the risk of cancer-associated thrombosis [176].…”

Section: Exogenous Dnases As Antimetastatic and Antitumor Agentsmentioning

confidence: 99%

Role of Cell-Free DNA and Deoxyribonucleases in Tumor Progression

Alekseeva

Миронова

2021

IJMS

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Many studies have reported an increase in the level of circulating cell-free DNA (cfDNA) in the blood of patients with cancer. cfDNA mainly comes from tumor cells and, therefore, carries features of its genomic profile. Moreover, tumor-derived cfDNA can act like oncoviruses, entering the cells of vulnerable organs, transforming them and forming metastatic nodes. Another source of cfDNA is immune cells, including neutrophils that generate neutrophil extracellular traps (NETs). Despite the potential eliminative effect of NETs on tumors, in some cases, their excessive generation provokes tumor growth as well as invasion. Considering both possible pathological contributions of cfDNA, as an agent of oncotransformation and the main component of NETs, the study of deoxyribonucleases (DNases) as anticancer and antimetastatic agents is important and promising. This review considers the pathological role of cfDNA in cancer development and the role of DNases as agents to prevent and/or prohibit tumor progression and the development of metastases.

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“…110 The use of rhDNase I for lobar atelectasis treatment was also reported in a lung cancer patient in 2019. 111 In a mouse silica-induced lung inflammation model, DNase I treatment reduces the amount of dsDNA in the bronchoalveolar space, preventing STING pathway activation. 112 In patients with CF, whether the cGAS-STING pathway is activated by the DNA accumulation as well as whether rhDNase also prevents STING activation is unclear and warrants further investigation.…”

Section: Cystic Fibrosismentioning

confidence: 99%

The cGAS‐STING pathway: The role of self‐DNA sensing in inflammatory lung disease

Serrano

Davis

et al. 2020

FASEB j.

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The presence of DNA in the cytosol is usually a sign of microbial infections, which alerts the host innate immune system to mount a defense response. Cyclic GMP‐AMP synthase (cGAS) is a critical cytosolic DNA sensor that elicits robust innate immune responses through the production of the second messenger, cyclic GMP‐AMP (cGAMP), which binds and activates stimulator of interferon genes (STING). However, cGAS binds to DNA irrespective of DNA sequence, therefore, self‐DNA leaked from the nucleus or mitochondria can also serve as a cGAS ligand to activate this pathway and trigger extensive inflammatory responses. Dysregulation of the cGAS‐STING pathway is responsible for a broad array of inflammatory and autoimmune diseases. Recently, evidence has shown that self‐DNA release and cGAS‐STING pathway over‐activation can drive lung disease, making this pathway a promising therapeutic target for inflammatory lung disease. Here, we review recent advances on the cGAS‐STING pathway governing self‐DNA sensing, highlighting its role in pulmonary disease.

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Bronchoscopic instillation of DNase to manage refractory lobar atelectasis in a lung cancer patient

Cited by 9 publications

References 11 publications

Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report

Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report

Role of Cell-Free DNA and Deoxyribonucleases in Tumor Progression

The cGAS‐STING pathway: The role of self‐DNA sensing in inflammatory lung disease

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