Mucolytics for Intubated Asthmatic Children: A National Survey of United Kingdom Paediatric Intensive Care Consultants

Abstract

Aim. The extent to which mucolytics are utilised in mechanically ventilated asthmatic children is unknown. We sought to establish current practice in the United Kingdom (UK) including choice of mucolytic, dose, and frequency of utilisation. Methods. A national electronic survey was distributed to UK consultants during April and May 2014. We were able to identify 168 PICU consultants at 25 institutions to whom we were able to electronically distribute a survey, representing an estimated 81% of UK NHS PICU consultants. Results. Replies were received from 87 consultants at 21 institutions (response rate = 52%). Recombinant human DNase (rhDNase) does get administered by 63% of clinicians, with 54% and 19% that administer hypertonic saline or N-acetylcysteine, respectively. Of those that do administer rhDNase the majority (48%) dilute it with 0.9% saline and blindly administer it, whereas 35% administer rhDNase under bronchoscopic guidance and 17% judge the necessity for bronchoscopy according to clinical severity. 25 respondents described 7 different methods to calculate rhDNase dose. A majority (87%) of respondents expressed an interest to consider enrolling patients into an RCT that evaluates rhDNase. Conclusion. Significant variation exists regarding the necessity for mucolytics, choice of agent, optimal route, and dose in intubated asthmatic children.

Identifying and Understanding Risk Factors for Instability and Adverse Events Associated With Chest Physiotherapy in Ventilated Children

“…DNase was delivered via nebulisation and instillation, whereas hypertonic saline was predominantly nebulised. This is in line with practice described in published literature (den Hollander et al, 2020, Snoek andBrierley, 2015).…”

“…All physiotherapists in this study reported using at least one mucoactive agent, with hypertonic saline and DNase the most popular. In a UK survey of mucoactive use for ventilated asthmatic children, 63% (55/87) of PICU consultants reported using DNase and 54% (46/85) hypertonic saline (Snoek and Brierley, 2015).…”

Prophylactic Use of Nebulized Hypertonic Saline in Mechanically Ventilated Children: A Randomized Blinded Pilot Study

“…17 Although our data do not support routine use of hypertonic saline in mechanically ventilated children, survey data show that hypertonic saline is prescribed routinely during mechanical ventilation by a large number of pediatric ICU physicians. 18 Our study provides these practitioners with previously unavailable data pertaining to adverse effects of hypertonic saline in children undergoing mechanical ventilation. We are unaware of any prior prospective data reporting the incidence of post-hypertonic saline wheezing in ventilated children.…”

Rational use of mucoactive medications to treat pediatric airway disease

“…There is no evidence of a clinical benefit of dornase alfa in children [90] or adults [91] with moderate to severe asthma. Nevertheless, some clinicians appear to use dornase alfa in mechanically ventilated children, [92] fueled by case reports showing improvement agent [93,94]. The administration of NAC in asthma has met with very limited success, as more recently assessed in a systematic review and meta-analysis.…”