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Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus

Durward, Andrew MBChB, FCP; Forte, Vito MD; Shemie, Sam D. MD, CM

Case Reports

Objective: To report the dramatic resolution of unilateral mucus plugging and atelectasis in a mechanically ventilated child with refractory status asthmaticus after intratracheal recombinant human DNase (rhDNase) therapy.

Design: Case report.

Setting: Critical care unit.

Patient: A 7-yr-old boy with status asthmaticus, severe respiratory failure and barotrauma unresponsive to conventional therapy. Fiberoptic bronchoscopy confirmed widespread mucus impaction of the subsegmental bronchi of the left lung without response to bronchoscopic lavage.

Interventions: Two 10-mg doses of intratracheal rhDNase were administered 8 hrs apart.

Main Results: The left-sided atelectasis resolved 3 hrs after the first dose of rhDNase. Improvements in gas exchange and tidal volumes were sustained and particularly noticeable after the second dose. The patient was successfully extubated 26 hrs after receiving the rhDNase treatment without any adverse effects.

Conclusions: rhDNase should be considered as a potential therapy for refractory mucus plugging and atelectasis in intubated patients with status asthmaticus.

From the Department of Critical Care Medicine (Drs. Durward, Shemie) and the Department of Otolaryngology (Dr. Forte), The Hospital for Sick Children, University of Toronto.

Copyright © by 2000 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.