İbrahim KARAMAN, Nurullah OKUMUŞ, Ayşe KARAMAN, Emrah ŞENEL, Çağatay Evrim AFŞARLAR, Engin YILMAZ, Ahmet ERTÜRK

Özofagus Atrezisi Operasyonu Sonrası Gelişen Dirençli Atelektazinin rhDNase ile Tedavisi

Özefagus atrezisinin cerrahisi sonrası dirençli atelektazi gelişen hastaların tedavisinde rhDNase uygulanması daha önceliteratürde bildirilmemiştir. Bu çalışmayla biz, özofagus atrezisi operasyonu sonrasında gelişen ve konvansiyonel yöntemlerledüzelmeyen, sağ akciğer atelektazili iki olgunun rhDNase ile tedavi sonuçlarını sunmayı amaçladık.On beş günlük kız bebek özofageal atrezi ve distal trakeoözofageal fistül nedeniyle opere edildikten 11 gün sonra sağakciğerinde atelektazi gelişti. Standart tedavilere cevap alınamadı. Postoperatif 20. gün rijit bronkoskopi yapıldı. Atelektazikısmen açıldı ancak tekrar etti. 26. gün nebulüzatörle rhDNase tedavisi başlandı. 2 gün boyunca, günde 3 kez1.25mg dozda rhDNase uygulandı. Her 3 dozluk tedavi sonunda kontrol akciğer grafileri çekildi. İkinci gün sonundahastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi.Özofageal atrezi ve distal trakeoözofageal fistül nedeniyle 3 günlükken opere edilen, 7 günlük erkek bebekte, sağ akci-ğerde atelektazi gelişti. Hastaya standart atelektazi tedavileri uygulandı, fakat atelektazide düzelme olmadı. Postoperatif9.gün hastaya rhDNase tedavisi başlandı. Hastaya, ilk olguda uygulandığı şekliyle, 2 gün boyunca rhDNase tedavisiuygulandı. İkinci gün sonunda hastanın atelektazisinin tamamen düzeldiği görüldü ve tekrar etmedi. Özefagus atrezisi operasyonu geçirmiş yenidoğanlarda postoperatif gelişen dirençli atelektazilerin tedavisinde rhDNase alternatif olabilir.

Treatment of Resistant Atelectasis After Esophageal Atresia Repair with rhDNase

There is no previous literature report on the use of rhDNase treatment in patients developing resistant atelectasis after esophagus atresia surgery, to the best of our knowledge. We aimed to present the results of rhDNase treatment in two cases that developed right lung atelectasis after esophageal atresia repair and did not respond to conventional treatment.A 15-day-old girl was operated for esophageal atresia with distal tracheoesophageal fistula and developed right lung atelectasis on the postoperative 11th day. Standard conservative treatment failed and rigid bronchoscopy was performed on the postoperative 20th day. The atelectasis partly improved but subsequently recurred. We started nebulization with rhDNase on postoperative day 26 and three doses per day were administered for 2 days with each dose containing 1.25 mg of rhDNase. A chest X-ray was obtained at the end of the three doses. A full recovery in the patient's atelectasis was observed after 2 days and no recurrence occurred.A 7-day-old boy who underwent esophageal atresia with distal tracheoesophageal fistula repair when 3 days old developed right atelectasis. The patient received standard treatment but the atelectasis did not improve. The patient was treated with rhDNase for two days starting on the 9th postoperative day using the same dose as the first case. A full recovery in the patient's atelectasis was observed after 2 days and no recurrence occurred. We found rhDNase treatment to be potentially useful to cope with resistant atelectasis of postoperative origin in newborns that have undergone surgical intervention for esophagus atresia.

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1. Peroni DG, Boner AL. Atelectasis: Mechanisms, diagnosis and management. Paediatr Respir Rev 2000;1:274-8.
2. Kaditis AG, Motoyama EK, Zin W, Maekawa N, Nishio I, Imai T, et al. The effect of lung expansion and positive end-expiratory pressure on respiratory mechanics in anesthetized children. Anesth Analg 2008; 106:775.
3. Okada A, Usui N, Inoue M, Kawahara H, Kubota A, Imura K, et al. Esophageal atresia in Osaka: A review of 39 years' experience. J Pediatr Surg 1997;32:1570-4.
4. Altunhan H, Annagür A, Pekcan S, Ors R, Koç H. Comparing the efficacy of nebulizer recombinant human DNase and hypertonic saline as monotherapy and combined treatment in the treatment of persistent atelectasis in mechanically ventilated newborns. Pediatr Int 2012;54:131-6.
5. Abu-Hasan MN, Chesrown SE, Jantz MA. Successful use of bronchoscopic lung insufflation to treat left lung atelectasis. Pediatr Pulmonol 2013;48:306-9.
6. Wagener JS, Kupfer O. Dornase alfa (Pulmozyme). Curr Opin Pulm Med 2012;18:609-14.
7. Ozturk E, Tanidir IC, Haydin S, Onan IS, Odemis E, Bakir I. The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery. Cardiol Young 2013;6:1-6.
8. Galvis AG, Reyes G, Nelson WB. Bedside management of lung collapse in children on mechanical ventilation: Saline lavage- -simulated cough technique proves simple, effective. Pediatr Pulmonol 1994;17:326-30.
9. Uchida K, Inoue M, Otake K, Okita Y, Morimoto Y, Araki T, et al. Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia. Pediatr Surg Int 2006;22:496-9.
10. Usui N, Kamata S, Ishikawa S, Sawai T, Okuyama H, Imura K, et al. Anomalies of the tracheobronchial tree in patients with esophageal atresia. J Pediatr Surg 1996;31:258-62.
11. Erdeve O, Uras N, Atasay B, Arsan S. Efficacy and safety of nebulized recombinant human DNase as rescue treatment for persistent atelectasis in newborns: Case-series. Croat Med J 2007;48:234-9.
12. Dilmen U, Karagol BS, Oguz SS. Nebulized hypertonic saline and recombinant human DNase in the treatment of pulmonary atelectasis in newborns. Pediatr Int 2011;53:328-31.
13. Riethmueller J, Kumpf M, Borth-Bruhns T, Brehm W, Wiskirchen J, Sieverding L, et al. Clinical and in vitro effect of dornase alfa in mechanically ventilated pediatric non-cystic fibrosis patients with atelectases. Cell Physiol Biochem 2009;23:205-10.