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

Crit Care Med. 2000 Feb;28(2):560-2. doi: 10.1097/00003246-200002000-00045.


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.

Publication types

  • Case Reports

MeSH terms

  • Bronchoalveolar Lavage
  • Bronchoscopy
  • Child
  • Deoxyribonuclease I / pharmacology
  • Deoxyribonuclease I / therapeutic use*
  • Expectorants / pharmacology
  • Expectorants / therapeutic use*
  • Humans
  • Instillation, Drug
  • Male
  • Mucus*
  • Pulmonary Atelectasis / diagnostic imaging
  • Pulmonary Atelectasis / drug therapy*
  • Pulmonary Atelectasis / etiology*
  • Pulmonary Atelectasis / metabolism
  • Pulmonary Atelectasis / physiopathology
  • Pulmonary Gas Exchange / drug effects
  • Radiography
  • Recombinant Proteins / pharmacology
  • Recombinant Proteins / therapeutic use
  • Respiration, Artificial / adverse effects*
  • Status Asthmaticus / therapy*
  • Tidal Volume / drug effects
  • Time Factors


  • Expectorants
  • Recombinant Proteins
  • DNASE1 protein, human
  • Deoxyribonuclease I