Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis*

Slattery, Dubhfeasa; Waltz, David A.; Denham, B; O’Mahony, M.; Greally, Peter

doi:10.1002/ppul.1062

Cited by 43 publications

(29 citation statements)

References 21 publications

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“…68 Less is known about effectiveness in the acute setting, although it has been instilled bronchoscopically to treat persistent lobar atelectasis unresponsive to IV antibiotics and chest physiotherapy. 69,70 Another agent, N-acetylcysteine (mucomyst), depolymerizes mucus in vitro. 71 A metaanalysis, reviewing both nebulized and oral administration, demonstrated minimal to no benefit with either route.…”

Section: Mucolyticsmentioning

confidence: 99%

Intensive Care Management of the Patient With Cystic Fibrosis

Kremer

Zwerdling

Michelson

et al. 2008

J Intensive Care Med

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Cystic fibrosis was previously thought to be a disease of childhood. With a better understanding of this condition along with improvements in therapy, patients with cystic fibrosis are now living well into adulthood. The aim of this article is to familiarize the intensive care unit physician with cystic fibrosis care, to discuss complications associated with cystic fibrosis specifically related to the intensive care unit, and to detail the current recommendations for the clinical management of the patient with cystic fibrosis. With advancing disease, the most severely affected organs are the lungs. Obstruction, infection, and inflammation contribute to the decline of pulmonary function, ultimately leading to death. Some patients may be eligible for lung transplantation, but choosing wisely will affect posttransplant survival. Because other organs are affected by the genetic defect and associated treatments, serious complications related to the liver, pancreas, intestines, and kidneys must be considered by the intensivist faced with a patient with cystic fibrosis. As practitioners, the fact that not all patients will survive and help our patients and families gracefully through the end-of-life process should be accepted.

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Section: Mucolyticsmentioning

confidence: 99%

Intensive Care Management of the Patient With Cystic Fibrosis

Kremer

Zwerdling

Michelson

et al. 2008

J Intensive Care Med

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“…Furthermore, in persistent atelectasis unresponsive to medical therapy bronchoscopic instillation of recombinant human DNase has been found to be useful [17].…”

Section: Drug Applicationmentioning

confidence: 99%

Flexible endoscopy of paediatric airways

Midulla¹,

Blic²,

Barbato³

et al. 2003

Eur Respir J

213

167

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Paediatric fibreoptic bronchoscopy is used for ever wider indications, and increasingly used in many contexts, including paediatric and neonatal intensive care.The report of this Task Force contains an overview on the current applications of paediatric bronchoscopy. The report discusses the facilities and equipment needed for the procedure, including the newly developed bronchoscopes which are allowing intervention even in very small children. The indications of both flexible and rigid bronchoscopes in the context of newer and smaller flexible endoscopic equipment are also considered. The care of the instruments, including disinfection and sterilisation, is fully documented. Patient management is described, including the relative merits of conscious sedation and general anaesthesia, as well as special settings for the procedure, including the needs in intensive care.Special procedures, increasingly performed bronchoscopically are described. These include bronchoalveolar lavage, endobronchial and transbronchial biopsy, laser therapy, bronchography, and endoscopic intubation and drug therapy. Finally, neonatal bronchoscopy is discussed, and the ethics of bronchoscopic procedures, including bronchoscopic research in children.Advances in instrumentation, and also improved anaesthetic techniques, allow fibreoptic bronchoscopy to be safely performed in even very small, sick infants, provided proper precautions are taken. Eur Respir J 2003; 22: 698-708.

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“…During acute pulmonary exacerbation, Dornase alfa appears to be safe and well tolerated but does not show a statistically significant therapeutic effect when added to antibiotics and physiotherapy [91]. However, bronchoscopic instillation of Dornase alfa has been used successfully for lobar atelectasis in CF, which is unresponsive to medical therapy [92].…”

Section: Airway Surface Liquid Hydrators/mucolyticsmentioning

confidence: 99%

Treatment of pulmonary exacerbations in cystic fibrosis

Bhatt¹

2013

Eur Respir Rev

129

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Pulmonary exacerbations have very important consequences in cystic fibrosis (CF), both in terms of current morbidity as well as implications for long term morbidity and mortality. Even though there is no universally agreed definition of pulmonary exacerbation, prompt and aggressive treatment with a multidisciplinary approach is recommended. Maintenance treatments reduce the risk of exacerbations. Antibiotics should be targeted against the common CF bacteria and these can be given orally, although i.v. antibiotics will be required for ongoing symptoms or severe exacerbations. The evidence base for recommendations regarding the optimal regimens, route and frequency of administration of antibiotics, location, and duration of i.v. antibiotic treatment will be discussed. Management of comorbidities, like poor nutrition and diabetes, is critical in improving outcomes. @ERSpublications Pulmonary exacerbations in CF require prompt and aggressive treatment and a multidisciplinary approach is recommended

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Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis*

Cited by 43 publications

References 21 publications

Intensive Care Management of the Patient With Cystic Fibrosis

Intensive Care Management of the Patient With Cystic Fibrosis

Flexible endoscopy of paediatric airways

Treatment of pulmonary exacerbations in cystic fibrosis

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