Mucolytics and the critically ill patient: help or hindrance?

Patients in the intensive care unit (ICU) with compromised lung function often have excessive pulmonary secretions and have difficulty clearing mucus. A variety of pharmacotherapeutics have been used in an attempt to change the rate, amount, and viscosity of respiratory secretions. These drugs are known as mucokinetic or mucolytic drugs, but their efficacy remains controversial in the research literature. Most commonly used methods of mucolysis/mucokinesis include: bland aerosols (saline), pH adjustment (sodium bicarbonate), and disulfide disruption (N-acetylcysteine, MUCOMYST). Clinical research needs to be done on the use of recombinant human deoxyribonuclease (rhDNase) in ICU patients because recombinant human deoxyribonuclease affects only purulent secretions, which makes it a safe, easily tolerated compound. Nursing interventions in the control of mucus in the ICU patient needs to be re-examined in light of recent research where the efficacy of chest percussion was questioned, as was the use of saline bolus instillation before suctioning and the potential for dornase alfa.