The Efficacy of Dornase Alpha (Polmozyme) in Resolving Persistent Atelectasis in Pediatric Critical Care

Background and objective Dornase alpha can be considered an alternative therapy when the standard therapy fails, but evidence of nebulization through artificial airways for persistent pulmonary atelectasis is limited. The study aimed to determine the efficacy of dornase alpha nebulization on persistent atelectasis in non-cystic fibrosis patients with and without artificial airways. Methodology A retrospective cross-sectional study was conducted on patients admitted to the Pediatric Intensive Care Unit (PICU) of King Fahad Medical City (KFMC) between February 2020 and October 2023. The pre- and post-treatment MRAS (Modified Radiologically Assisted Score) was used to determine the treatment efficacy. The independent t-test and chi-square test were used for statistical analysis. Multivariate regression analysis was applied after estimating the propensity score to adjust baseline characteristics to reduce selection and indication bias. A value of p<0.05 was taken to indicate statistical significance. Results Dornase alpha was not an independent positive predictor of MRAS score improvement (B=0.326, p=0.757, Exp(B)=1.385) beyond other variables. However, the dornase group (n = 132) significantly improved the mean MRAS score by 6.08+2.69 compared to the non-dornase group's (n=143) mean MRAS score of 5.14+2.4, with a moderate effect size (Cohen's d=0.364, 95% CI: 0.126 to 0.603; p=0.03) in resolving persistent atelectasis. Conclusion Dornase alpha did not independently improve MRAS scores in pediatric patients with persistent atelectasis, controlling for selection/indication bias and confounding variables. The observed differences in MRAS improvement in the initial analysis were most likely due to baseline differences.