First author, year of publication | Study design | Geography | Patient population | Intervention (I) route and control (C) treatment | Main findings according to primary and secondary systematic review outcomes |
Riethmueller 2006*21 | RCT | Germany, PICU | Invasive MV after cardiac surgery (n=88) Age: 0–2 years | I=dornase alfa by tracheal instillation C=0.9% saline | Shorter duration of MV (2.2 vs 3.4 days, p=0.043), length of stay and incidence of atelectasis. Similar re-intubation rates |
Hendriks 200531 | Retrospective observational study, before-after analysis | The Netherlands, PICU and medium care | Patients with atelectasis (n=30, but n=25 on PICU with n=16 on MV) Age: 1.6 years median | I=dornase alfa by nebulisation or tracheal instillation | Duration of MV <6 days in 12/16 patients. Improvement in chest X-ray scores and oxygenation/ventilation indices (eg, pCO2, FiO2) before-after (p<0.01). Transient desaturation (n=3) |
Riethmueller 200922 | Retrospective observational study with historical control group, before-after analysis | Germany, PICU | Invasive MV with atelectasis (intervention group, n=46) or after cardiac surgery (historical control group from ref 21, n=17) Age: 0.48 years median | I=dornase alfa by tracheal instillation C=NaCl 0.9% | Improvement of chest X-ray atelectasis in 67% of patients receiving dornase alfa, vs 6% in controls. Improvement of respiratory mechanics and oxygenation (airway pressures, FiO2) |
Prodhan 200920 | Retrospective observational study, before-after analysis | USA, PICU | Invasive MV with atelectasis and congenital cardiac disease (n=38) Age: 3.5 months median | I=dornase alfa for <14 days by nebulisation | Improvement of chest X-ray atelectasis (p<0.05). No change in respiratory mechanics/ventilation indices, small decrease in FiO2 (p<0.001). No adverse events |
Ozturk 201419 | Retrospective observational study, case-control and before-after analysis | Turkey, PICU | Postoperative atelectasis after congenital heart surgery (n=41) Age: 25.5 days median (dornase group) and 50.0 days median (control group) | I=dornase alfa by tracheal instillation or nebulisation C=conventional medication (eg, albuterol)+chest physiotherapy | Improvement chest X-ray atelectasis (p<0.01) and oxygenation indices (pO2, p=0.04) in dornase alfa group vs non-significant in control group |
Greally 199532 | Case report | Ireland, PICU | Invasive MV for status asthmaticus with complete lung atelectasis in 8-year-old female | I=dornase alfa by tracheal instillation with bronchoscopy | Complete resolution atelectasis with fast clinical improvement (not specified). No adverse effects |
Durward 200025 | Case report | Canada, PICU | Invasive MV for status asthmaticus with atelectasis in 7-year-old male | I=dornase alfa by tracheal instillation with bronchoscopy | Resolution atelectasis and fast improvement in respiratory mechanics and ventilation/oxygenation indices. No adverse effects |
Patel 200026 | Case report | UK, PICU | Invasive MV for refractory status asthmaticus in 3-year-old male | I=dornase alfa by tracheal instillation with bronchoscopy | Fast improvement in respiratory mechanics and ventilation indices (pCO2). No adverse effects |
Merkus 200124 | Case report | The Netherlands, PICU | Infants with severe RSV bronchiolitis (n=5, with n=3 with invasive MV) 2–29 weeks old | I=dornase alfa by nebulisation | Differential improvement in chest X-ray/atelectasis, improvement in oxygenation/ventilation indices. No adverse effects |
Manna 200323 | Case report | UK, PICU | Invasive MV with plastic bronchitis and acute chest syndrome (sickle cell disease) in 7-year-old male | I=dornase alfa by tracheal instillation with bronchoscopy/chest physiotherapy | Improvement in chest X-ray, removal of bronchial casts, improvement in ventilation indices |
*More detailed information on the RCT of Riethmueller 2006 is reported in the main results and online supplemental tables 1 and 2.
CF, cystic fibrosis; FiO2, fraction of inspired oxygen; MV, mechanical ventilation; pCO2, partial pressure of carbon dioxide; PICU, paediatric intensive care unit; pO2, partial pressure of oxygen; RCT, randomised controlled trial; RSV, respiratory syncytial virus.