Dornase Alpha Compared to Hypertonic Saline for Lung Atelectasis in Critically Ill Patients

Youness, Houssein; Mathews, Kathryn; Elya, Marwan; Kinasewitz, Gary T.; Keddissi, Jean I.

doi:10.1089/jamp.2011.0954

Cited by 17 publications

(18 citation statements)

References 27 publications

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“…A total of two trials were included [ 19 , 20 ] (Additional file 1 and Table 1 ). The main reason for exclusion was that the trials were conducted in patients with CF and/or pediatric patients.…”

Section: Resultsmentioning

confidence: 99%

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

2015

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BackgroundNebulised dornase alfa is used off-label in critically ill patients. We aimed to assess the benefits and harms of nebulised dornase alfa versus placebo, no prophylaxis, or hypertonic saline on patient-important outcome measures in adult critically ill patients.MethodsWe performed a systematic review with meta-analysis and trial sequential analysis (TSA) using the Cochrane Collaboration methodology. Eligible trials were randomised clinical trials comparing nebulised dornase alfa with placebo, no prophylaxis, or hypertonic saline. The predefined outcome measures were all-cause mortality, duration of mechanical ventilation, length of stay, and adverse events. Two reviewers independently assessed trials for inclusion, data extraction, and risk of bias. Risk ratios (RRs) with 95 % confidence intervals (CIs) were estimated by conventional cumulative meta-analysis, and the robustness of the primary estimate was assessed by TSA.ResultsTwo trials (n = 63) were included; both were judged to have high risk of bias. There was no statistically significant difference in mortality (random effects model RR (95 % CI) 0.73 (0.09–5.77); P = 0.24; I2 = 30 %). TSA could not be conducted because less than 1 % of the required information size had been accrued. None of the two trials reported adequate and detailed data on any of the secondary outcome measures.ConclusionsWe found very low quantity and quality of evidence for use of nebulised dornase alfa in adult critically ill patients in this systematic review with meta-analysis.Systematic review registrationThe International Prospective Register of Systematic Reviews (PROSPERO), no. CRD442015016047.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0142-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

2015

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“…11 In contrast, a study by Youness HA, et al rejected the effectiveness of inhaled rhDNase. 12 A study by Dilmen U, et al stated that 3% HS solution was a more effective therapeutic option on the basis of clinical and radiological improvement compared to rhDNase treatment in newborns with pulmonary atelectasis. 5…”

Section: Discussionmentioning

confidence: 99%

Recurrent atelectasis in a preterm neonate

Kamalammal

Venkatamurthy

Niranjan

2016

Int J Contemp Pediatr

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Excessive or thick pulmonary secretions obstructing the small airways are a common problem in neonatal population. Pulmonary collapse may occur secondary to mucus plug. Recombinant-DNase is thought to improve atelectasis by decreasing viscosity and assisting mucociliary clearance in cases of pulmonary collapse. Inhaled hypertonic saline is tried as an alternative. Here we report a case of respiratory distress syndrome with collapse of entire left lower lobe which is very rare and it responded significantly to hypertonic saline nebulisation along with chest physiotherapy and regular suctioning. Atelectasis is common in post extubated neonates but in our case it developed in pre intubation period. Here we highlight the fact that nebulized hypertonic saline can be an effective alternative to recombinant DNase in resource limited settings like in India.

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“…Dornase alfa has positive long-term effects on lung function in cystic fibrosis (CF) [9,12], with promise in severe, acute asthma [13]. There have been reports of atelectasis and sputum plugging resolution in acute, non-CF adults, and pediatrics [14][15][16][17]; however, robust trials in pediatric bronchiolitis and tracheomalacia [18,19], as well as mechanically ventilated adults [20][21][22][23][24] report no benefit. Dornase alfa may also be detrimental, negatively affecting lung function and exacerbations in non-CF bronchiectasis [22,25,26].…”

Section: Introductionmentioning

confidence: 99%

“…Assessed and eligible (n =95)Excluded (n = 63) -Declined to participate(15) -Not suitable to modify ACT (10) -Medically unstable (5) -Unable to complete MBW (2) -Missed recruitment window (11) -Respiratory isolation(20) ITT analysis (n = 16) Complete data for primary outcome(13) Missing baseline LCI(2)Missing 1+3 month LCI(1)Lost to follow-up: death (n = 1) Discontinued intervention: (critically ill / AE)(2) Allocated to isotonic saline (n = 16) -Received allocated intervention(16)Lost to follow-up: death (n = 1) Discontinued intervention: (AE)(1) Allocated to dornase alfa (n = 16) -Received allocated intervention(16) ITT analysis (n = 16) Complete data for primary outcome(13) Missing 1+3 month LCI (2) Missing 3 month LCI (1) CONSORT diagram. ACT, airway clearance technique; AE, adverse event; CONSORT, consolidated standards of reporting trials; LCI, lung clearance index; MBW, multiple breath washout; n, number.…”

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confidence: 99%

Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial

et al. 2019

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Summary Lung transplant (LTx) recipients are at risk of lower respiratory tract infection (LRTI), while altered physiology may lead to difficulty clearing sputum. Mucoactive agents alter sputum properties and facilitate mucociliary clearance; however, there are no randomized controlled trials (RCTs) studying this post‐LTx. This RCT evaluated the safety and efficacy of nebulized dornase alfa during LRTI post‐LTx. Inpatient adults with LRTI and abnormal sputum following bilateral sequential LTx were eligible. Participants received 5 ml of isotonic saline, or 2.5 ml of dornase alfa, nebulized once daily for 1 month followed by 2 months symptom diary. Primary outcome was lung clearance index (LCI2%). Secondary outcomes included spirometry, quality of life, readmission, length of stay, self‐reported exacerbations, and adverse events at baseline, 1 and 3 months. Thirty‐two participated, 16 in each group, baseline mean (SD) FEV1% 58 (22), median (IQR) length of stay 7 (5) days, time since LTx 3.49 (6.80) years. There were no significant between‐group differences in LCI2% at any point (1 month mean difference −0.34, 95% confidence interval (CI) −1.57 to 0.89; 3 months −0.76, 95% CI −2.29 to 0.78, favoring dornase alfa). Secondary outcomes were not different between groups. These results do not support the routine use of dornase alfa during LRTI in LTx recipients.

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Dornase Alpha Compared to Hypertonic Saline for Lung Atelectasis in Critically Ill Patients

Cited by 17 publications

References 27 publications

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

Recurrent atelectasis in a preterm neonate

Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial

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