Mucoactive agents for adults with acute lung conditions: A systematic review.

Benjamin J Tarrant, Caitlin Le Maitre, Lorena Romero, Ranjana Steward, Brenda M Button, Bruce R Thompson, Anne E Holland

Journal: Heart & lung : the journal of critical care 2020;48(2):141-147

PMID: 30409442

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND OBJECTIVES

Inhaled mucoactive agents are used to enhance airway clearance, however efficacy and safety are unclear in adults with acute respiratory conditions.

METHODS

We systematically reviewed randomized controlled trials assessing respiratory function; safety; length of stay (LOS); mucus; radiology; and oxygenation.

RESULTS

No adverse events were reported for dornase alfa (n = 63), N-acetylcysteine (NAC, n = 50), ambroxol (n = 140), hypertonic saline (n = 33), heparin (n = 384), mannitol (n = 20) or isotonic saline. During invasive ventilation, NAC, dornase alfa and saline had no effect on mucus. Postoperatively, mucus characteristics improved with NAC (n = 10). Ambroxol lowered LOS (mean difference 4 days) and halved complications following lung carcinoma resection (n = 140). Heparin improved ventilator-free days (n = 130, mean difference 3.9-4.6) and intensive care LOS (n = 223, 3.2 days), but not ventilator-acquired pneumonia.

CONCLUSION

Dornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness.

Address: Physiotherapy Department, Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; La Trobe University, Level 4, The Alfred Centre, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].; Physiotherapy Department, Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.; Physiotherapy Department, Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; Monash University, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.; Physiotherapy Department, Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; La Trobe University, Level 4, The Alfred Centre, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.

DOI: 10.1016/j.hrtlng.2018.09.010

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MeSH Terms: Acute Disease, Administration, Inhalation, Adult, Ambroxol, Deoxyribonuclease I, Expectorants, Humans, Lung Diseases, Mannitol, Mucociliary Clearance, Recombinant Proteins