Use of dornase alfa in the paediatric intensive care unit: current literature and a national cross-sectional survey.
Use of dornase alfa in the paediatric intensive care unit: current literature and a national cross-sectional survey.
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DOI：
10.1136/ejhpharm-2020-002507
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发表时间：
2022-05
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影响因子：
--
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中科院分区：
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气道粘液阻塞是儿科重症监护病房（PICU）收治儿童的主要挑战。我们的目的是评估在PICU非囊性纤维化条件下溶黏液药物dornase alfa的证据和当代使用。(1)我们在PubMed、EMBASE和Cochrane图书馆进行了系统的检索。研究选择：为了质量评估和数据综合，我们只纳入了随机对照试验（RCTs），比较了在PICU重症儿科患者（<18岁）中dornase alfa与标准治疗或安慰剂的疗效。然而，也讨论了非随机对照研究和病例系列。数据提取：由多名审稿人使用数据提取表格独立提取数据。主要观察指标为机械通气持续时间。数据综合：采用GRADE方法进行质量评价。不能进行meta分析。(2)对荷兰所有7个picu进行了全国横断面调查。该系统综述只产生了一项RCT，比较了心脏手术后儿童中dornase α和生理盐水的作用。在这项研究中，dornase α导致机械通气持续时间减少约1天（减少36%）。此外，我们还发现了9项回顾性观察和案例研究。调查显示，目前荷兰picu中dornase alfa的使用率很高：42%的受访者报告每周至少开具一次dornase alfa处方。只有4%的受访者报告说他们使用了当地的PICU治疗方案。在没有强有力的证据或当地协议的情况下，在PICU中频繁使用dornase alfa，这突出了对这种粘液溶解剂的有效性进行进一步研究的必要性。
Airway mucus obstruction is a major challenge in children admitted to the paediatric intensive care unit (PICU). We aimed to evaluate the evidence and contemporary use of the mucolytic medication dornase alfa for non-cystic fibrosis conditions in the PICU. (1) We performed a systematic review with searches in PubMed, EMBASE, and the Cochrane Library. Study selection: for quality assessment and data synthesis, we included only randomised controlled trials (RCTs) that compared dornase alfa to standard care or placebo in critically-ill paediatric patients (<18 years of age) in the PICU. However, non-randomised controlled studies and case series are also discussed. Data extraction: data were extracted independently by multiple reviewers using data extraction forms. The primary outcome was duration of mechanical ventilation. Data synthesis: The GRADE approach was used for quality assessment. No meta-analysis could be performed. (2) A national cross-sectional survey among all seven PICUs in the Netherlands was also performed. The systematic review yielded only one RCT, comparing dornase alfa with normal saline in children after cardiac surgery. In this study, dornase alfa led to a reduction in duration of mechanical ventilation by approximately 1 day (36% reduction). In addition, we found nine retrospective observational and case studies. The survey revealed high current use of dornase alfa in Dutch PICUs: 42% of the respondents reported prescribing dornase alfa at least once every week. Only 4% of the respondents reported having access to a local PICU dornase alfa protocol. The off-label use of dornase alfa in the PICU is frequent without strong evidence or local protocols, highlighting the need for further research on the effectiveness of this mucolytic agent.
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DOI：
10.1186/cc3544
发表时间：
2005-08
期刊：
Critical care (London, England)
影响因子：
--
作者：
Hendriks T;de Hoog M;Lequin MH;Devos AS;Merkus PJ
通讯作者：
Merkus PJ
DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
9.8
作者：
Patel, A;Harrison, E;Murdoch, IA
通讯作者：
Murdoch, IA
影响因子：
3.9
作者：
Icard, Bradley L.;Rubio, Edmundo
通讯作者：
Rubio, Edmundo
影响因子：
2
作者：
Maaskant, Jolanda M.;Tio, Marieke A.;Geukers, Vincent G. M.
通讯作者：
Geukers, Vincent G. M.