Unresponsive to conventional therapy. Method We reviewed retrospectively the case notes
Unresponsive to conventional therapy. Method We reviewed retrospectively the case notes of 19 ventilated patients admitted to a tertiary paediatric ICU with a clinical diagnosis of asthma or bronchiolitis who received rhDNAse Q-VD-OPhMedChemExpress QVD-OPH therapy for severe persisting hypercarbic acidosis (pCO2 > 10 kPa, pH < 7.2) despite optimising conventional ventilation (peak inspiratory pressure > 28 cmH2O, pressure control mode). One millilitre per kilogram of rhDNAse (0.25 mg/ml concentration in 0.9 saline) was instilled bronchoscopically (n = 4) or blindly (n = 15) into the trachea followed by percussive physiotherapy with adequate patient sedation and muscle relaxation. Ventilator settings (Servo 300) and arterial blood gases were recorded pre-DNAse and at 4 and 8 hours after therapy according to our standard DNAse protocol. Tidal volumes were not measured due to known inaccuracy of the Servo 300 ventilators. Data were analyzed using two-way, repeated-measures ANOVA. Significance levels for group (asthma vs bronchiolitis), time (0, 4 and 8 hours) and interaction effects are reported. Results Patient demographics are presented in Table 1. There was a significant fall in arterial pCO2 in both groups over the 8 hours after DNAse therapy (time effect P = 0.01, group effect P = 0.03; Fig. 1), which was mirrored by a rise in PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27797473 pH (time effect P = 0.002). This was associated with a reduction in peak inspiratory pressure (time effect P = 0.03; Fig. 2) which was more pronounced in asthma (interaction effect P = 0.004; Fig. 2). Patients with bronchiolitis were ventilated at a higher rate than asthma (group effect P = 0.001), which did not change with time (time effect P = 0.4), suggesting the reduced pCO2 was a function of improved tidal volumes. Conclusion Intratracheal DNAse with percussive physiotherapy may offer an effective method to improve ventilation in status asthmaticus and bronchiolitis patients with severe hypercarbic acidosis. Further studies are warranted.P51 Influence of rhDNAse on the duration of mechanical ventilation in intensive care patients: interim analysis of the LUFIT trialN Deschner, W Brehm, R Vonthein, J Riethmueller University of Tubingen, Germany Critical Care 2006, 10(Suppl 1):P51 (doi:10.1186/cc4398) Background rhDNAse is effective in the treatment of children with cystic fibrosis [1]. A significant reduction of the duration of ventilation by rhDNAse has been reported in children following cardiac surgery [2]. Objective To investigate whether rhDNAse is able to reduce the duration of ventilation in adult mechanically ventilated intensive care patients. Methods After approval of the local ethics committees we PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28404814 conducted a double-blind, placebo-controlled, randomised, multicentre national trial. Patients were stratified into two subgroups depending on their status as surgical or nonsurgical. The trial was started within 48 hours after the start of mechanical ventilation and lasted until weaning was successful. Patients in the active treatment group received 2.5 ml rhDNAse endotracheally twice a day. Patients in the placebo group received the same amount of normal saline. This interim analysis reviewed 98 nonsurgical patients. Data from 85 patients were included in the analysis.SAvailable online http://ccforum.com/supplements/10/STable 1 (abstract P52) Asthma (n = 8) Age (months) Days of ventilation Hours pre-DNAse 72.6 (48?04) 3.4(2.6?.5) 2.28(1.0?.9) Bronchiolitis (n = 11) 4.2(2.5?) 5.55(3.8?.9) 4.67(3.1?.9)Figure 1 (abstract P52)Aim To s.
