Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a c
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Molecular Medicine
SHORT REPORT
Open Access
Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series Andrew G. Weber1, Alice S. Chau2, Mikala Egeblad3*, Betsy J. Barnes4*
and Tobias Janowitz3,5
Abstract Background: Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods: Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results: The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drugassociated toxicities were identified. Conclusions: Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered. Keywords: SARS-CoV-2, COVID-19, Coronavirus, Mucopurulent secretions, Dornase alfa, Neutrophil extracellular traps, ARDS, VV-ECMO
Background Critically ill patients with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), progress to hypoxemic and then mixed respiratory failure, secondary to acute respiratory distress syndrome (ARDS) (Marini and Gattinoni 2020; Greenland et al. 2020). Approximately * Correspondence: [email protected]; [email protected] 3 Cancer Center, Cold Spring Harbor Laboratory, 1 Bungtown Road, Cold Spring Harbor, NY 11724, USA 4 Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research and the Departments of Molecular Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 350 Community Drive, Manhasset, NY 11030, USA Full list of author information is available at the end of the article
79–88% of patients admitted to the intensive care unit (ICU) with COVID-19 require intubation and mechanical ventilation, with a mortality of 24–53% (Cummings et al. 2020; Grasselli et al. 2020; Richardson et al. 2020; Docherty et al. 2020). ARDS in COVID-19 is characterized by respiratory failure, in part attributable to distally located mucopurulent secretions. Dorna
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