Treatment of lobar atelectasis with bronchoscopically administered recombinant human deoxyribonuclease in cystic fibrosis?

McLaughlin, Anne Marie; McGrath, Emmet E.; Barry, Rupert; Egan, Jim; Gallagher, Charles G.

doi:10.1111/j.1752-699x.2007.00024.x

Cited by 20 publications

(19 citation statements)

References 12 publications

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“…Very few patients do not respond to the above measures, especially those with bronchiectasis or structural airway abnormalities like bronchomalacia. The use of flexible bronchoscopy as a 'secondary' treatment along with installation of DNase is described in patients not responding to usual treatment in small case series, 2,3 but no literature is available on the use of early therapeutic bronchoscopy in cystic fibrosis. The cause for recurrent lobar atelectasis in our patient is yet to be determined.…”

Section: Discussionmentioning

confidence: 99%

Recurrent lobar atelectasis in a child with cystic fibrosis

Nagakumar

Hilliard

2012

J R Soc Med

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Section: Discussionmentioning

confidence: 99%

Recurrent lobar atelectasis in a child with cystic fibrosis

Nagakumar

Hilliard

2012

J R Soc Med

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“…One hypothesis is that a massive influx of inflammatory mediators and cells (primarily DNA-rich neutrophils) results in direct injury to the airway, leading to production of secretions and airway obstruction with mucus and products of inflammatory cell breakdown including DNA [1]. Some existing therapies such as anti-inflammatory agents or DNAse might be rational in this setting [2]. These agents are often used in clinical practice but there are few data specifically supporting a pathophysiologic rationale for their use [2–4].…”

Section: Introductionmentioning

confidence: 99%

“…Some existing therapies such as anti-inflammatory agents or DNAse might be rational in this setting [2]. These agents are often used in clinical practice but there are few data specifically supporting a pathophysiologic rationale for their use [2–4]. …”

Section: Introductionmentioning

confidence: 99%

“…Studies have demonstrated the importance of inflammatory cells and their breakdown products in the pathophysiology of cystic fibrosis (CF), in which DNA from necrotic neutrophils contributes to the viscosity of airway secretions that obstruct airways [8, 9]. There is evidence that the use of anti-inflammatory drugs or inhaled DNAse improves morbidity in CF [2, 3, 10, 11]. Inhaled DNAse has also been studied in mechanically ventilated pediatric patients with atelectasis and has been shown to decrease inflammation and improve atelectasis compared to mechanical ventilation maneuvers alone [4, 12].…”

Section: Introductionmentioning

confidence: 99%

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DNA and Inflammatory Mediators in Bronchoalveolar Lavage Fluid From Children With Acute Inhalational Injuries

Joyner

Jones

Cairns

et al. 2013

Journal of Burn Care & Research

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Objective Assess the feasibility of using serial bronchoalveolar lavage fluids (BALF) to characterize the course of cell damage and inflammation in airways of pediatric patients with acute burn or inhalation injury. Design Prospective, longitudinal descriptive pilot study. Setting Burn and Pediatric Intensive Care Units in a tertiary-care medical center. Subjects Six consecutive intubated, mechanically ventilated pediatric patients with acute inhalational injuries were studied. Interventions Serial BALF specimens from clinically-indicated bronchoscopies were used to measure DNA and cytokine levels. Measurements and Main Results BALF DNA levels for the 6 pediatric burn subjects were highest within the first 72 hours after burn injury and declined thereafter. At the early stages after injury, BALF DNA levels (median [min, max] 3789 [1170,11917] ng/ml) were similar to those in adult burn patients and pediatric cystic fibrosis or bronchiectasis patients, and higher than those in pediatric recurrent pneumonia patients. BALF DNA levels in children and adults with inhalation injury correlated significantly with BALF IL-6, IL-8, and TGF-β1 levels. The patient with the most severe early visible airway mucosal damage and soot pattern at bronchoscopy, as well as the most extensive burns, also had the highest average early BALF DNA level (11917ng/ml) and the longest ventilator course and hospital stay. Procedures were well tolerated. Conclusions In children with acute burn and inhalational injury, airway cellular damage and inflammation (reflected in high BALF DNA levels) appear to peak during the first 72 hours after burns or inhalation injury followed by a slow decline. Serial analysis of factors in airway secretions is feasible and has the potential to reveal important pathophyisiologic pathways and therapeutic targets for treatment of acute inhalational injuries.

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“…Sometimes biopsy forceps or foreign body basket may have to be used to remove extremely tenacious mucous plugs. Bronchoscopic instillation of recombinant human DNase through bronchoscope was successful in improving atelectasis due to thick tenacious airway secretions unresponsive to medical treatment in selected cases of cystic fibrosis [9].…”

mentioning

confidence: 99%

Acute Total Lung Collapse in a Woman with Acute Stroke and Atrial Fibrillation

Gowrinath

Reddy²

2017

JCDR

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A 60-year-old-woman was referred for evaluation of total opacification of left hemithorax with ipsilateral shift of mediastinum in supine chest radiograph [Table/ Fig-1]. Her latest Arterial Blood Gas (ABG) analysis showed a pH of 7.49, PaCO 2 of 50.3 mmHg, PaO 2 of 58.1 mmHg and HCO 3 -of 36 meq/L. She was on noninvasive ventilation with inspired Fraction of Oxygen (FiO 2 ) of 0.6 and was on amiodarone infusion to control atrial fibrillation. Two days back, patient was admitted into Intensive Care Unit (ICU) for acute stroke with left hemiplegia and atrial fibrillation. Her initial ABG report showed pH of 7.28, PaCo 2 of 67.4 mmHg, PaO 2 of 51.8 mmHg and HCO 3 of 26.2 mmol/L. Blood and urine reports were normal except for mild leucocytosis. Patient had pre-existing rheumatic heart disease with severe pulmonary arterial hypertension. A preadmission supine chest radiograph taken in the emergency room showed cardiomegaly and left perihilar patchy opacities [Table/ Fig-2]. A two dimensional transthoracic echocardiogram showed moderate mitral valve stenosis, severe tricuspid valve stenosis, severe pulmonary arterial hypertension and dilated right heart chambers. An ultrasound of chest suggested complete collapse of left lung with minimal effusion. Aggressive chest physiotherapy was avoided for fear of aggrevating atrial fibrillation. After obtaining high risk written consent, flexible bronchoscope (Pentax BF20) was introduced transnasally using 2% lidocaine jelly for lubrication while administering supplemental oxygen (FiO 2 of 1.0) through the other nostril under midazolam sedation. Further, Flexible Bronchoscopy (FB) was done under local anaesthesia with 10% lidocaine spray for oropharynx and 2% lidocaine instilled through the bronchoscope from glottic level. At carinal level, thick mucous plug was seen completely occluding the left main bronchial orifice. A 5 ml of normal saline was instilled over the mucous plug and negative suction was applied. Part of the mucous plug was sucked into the bronchoscope and completely occluded the lumen of suction channel and further negative suction failed to clear it. The bronchoscope was withdrawn and the mucous was pushed out of bronchoscope with the bronchial brush into the collection trap. In the same way, all visible mucous was sucked out and collected in the collection trap [Table/ Fig-3]. Electrocardiogram (ECG), oxygen saturation and blood pressure were monitored throughout the FB. FB was completed in about 8 minutes and was uneventful. A total of 20 ml of normal saline was instilled and bronchoscope was withdrawn twice to push the mucous out. At the end of procedure, breath sounds were well heard on auscultation over left lung. A post FB supine chest radiograph showed expansion of left lung [Table /Fig-4].Mucus may accumulate in dependent portions of lung if the patient is bedridden for long duration without spontaneous movements. The other predisposing factors of mucous accumulation and plugging of airway include ineffective or inability to cough, inadequate inspirator...

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Treatment of lobar atelectasis with bronchoscopically administered recombinant human deoxyribonuclease in cystic fibrosis?

Cited by 20 publications

References 12 publications

Recurrent lobar atelectasis in a child with cystic fibrosis

Recurrent lobar atelectasis in a child with cystic fibrosis

DNA and Inflammatory Mediators in Bronchoalveolar Lavage Fluid From Children With Acute Inhalational Injuries

Acute Total Lung Collapse in a Woman with Acute Stroke and Atrial Fibrillation

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