Inhaled Dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients

Background

Lobar or segmental collapse of the lung in mechanically ventilated patients is a common occurrence in the intensive care unit. Management is labor and time intensive and not highly effective.

Methods

We conducted a randomized, placebo-controlled, double-blind pilot study to determine whether nebulized Dornase alfa improves radiologic and clinical outcomes in ventilated patients with lobar atelectasis. Drug or placebo was administered twice daily until extubation, death, or transfer. The primary outcome was the total chest x-ray score: secondary outcomes of interest were oxygenation, lung compliance, and rate of extubation over the first 5 days. The groups consisted of 14 intervention patients and 16 control patients.

Results

There were no significant differences in “Total Chest X-Ray Score" or compliance over the 5 days of study. There was an improvement in oxygenation for the intervention group at day 5 (P = .03). In addition, this group was less likely to remain intubated over the first 24 hours of the study, a difference that did not persist over the course of the study.

Conclusions

Dornase alfa does not improve the appearance of atelectasis on chest radiographs, or the “Total Chest X-Ray Score" over the first 5 days of treatment in mechanically ventilated patients. The intervention group's higher rate of extubation during the first 24 hours as well as its improved oxygenation on day 5 were likely chance findings given the multiple potential confounders for extubation and low study power.