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  • Poster presentation
  • Open Access

Safety and efficacy of intratracheal DNase with physiotherapy in severe status asthmaticus

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  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care201115 (Suppl 1) :P185

  • Published:


  • Salbutamol
  • Extracorporeal Membrane Oxygenation
  • Airflow Limitation
  • Peak Inspiratory Pressure
  • Status Asthmaticus


Diffuse airway plugging with thick viscous secretions is recognised in acute severe asthma, and contributes to airflow limitation in ventilated asthmaticus. Since 2004, we have used intratracheal DNase with physiotherapy as second-line therapy in mechanically ventilated children with severe status asthmatics who are refractory to conventional medical management. Our aim is to report the safety profile and efficacy of intratracheal DNase mucolytic therapy in this cohort.


A retrospective cohort analysis in a 20-bed PICU. Forty-six ventilated children, median (IQR) age 74 months (45 to 141), received intratracheal DNase with physiotherapy (January 2004 to August 2010). Indication for DNase was peak inspiratory pressure (PIP) >28 cmH2O with hypercarbic acidosis (pCO2 > 10 kPa). Eleven patients required additional doses of DNase. In 40 episodes DNase was given blindly (n = 40) or bronchoscopically (n = 17).


The median (IQR) time to DNase following PICU admission was 2.1 hours (1.3 to 3.8). At the time of DNase, median PIP was 34 cm (30 to 40), pH was 7.12 (7.01 to 7.22) and pCO2 was 11 kPa (7.9 to 14.1). Overall DNase produced an improvement in ventilation (see Figure 1). Salbutamol IV was constant at 1 μg/kg/minute (0.5 to 2). The therapy was well tolerated with no hypoxic or hypotensive episodes, or air leaks. Median length of ventilation was 22 hours (15 to 37). No patient required extracorporeal membrane oxygenation and there were no deaths.
Figure 1
Figure 1

Fractional polynomial regression of PIP/PCO 2 following DNAse.


Intratracheal DNase with physiotherapy is safe and effective therapy for refractory ventilated patients with status asthmatics. A randomised control trial is warranted.

Authors’ Affiliations

Evelina Childrens Hospital, Guy's and St Thomas' NHS Trust, London, UK


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© Nyman et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.