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One limitation to our study was the 9-month data collection period. We acknowledge that it would have been beneficial to include an entire year of pre-guideline and
post-guideline implementation data due to seasonal changes
in patient populations and also recognize that it would be
difficult to compare seasonal changes from year to year.
Although it would have been beneficial to determine the
number of patients in these units with respiratory diagnoses
who did not receive mucolytics, the primary focus of this
study was the reduction in the use of dornase alfa overall.
Although the guidelines focused on restricting the use of
dornase alfa, we also saw a reduction in the use of additional
mucolytics, including acetylcysteine and hypertonic saline.
Currently, there is a lack of evidence regarding the use of
these mucolytics for airway clearance in the critically ill pediatric population. They are not currently recommended by
AARC, and provider education around these guidelines may
have contributed to the overall reduction in mucolytic use.
Following guideline implementation, we observed a
decrease in the utilization of dornase alfa, acetylcysteine, and
hypertonic saline. Although we cannot conclude that the
reduction in use of dornase alfa within the PICU and PCICU
resulted in a significant decrease in overall hospital stay for
patients, we can confirm that this reduction did not negatively
affect the hospital LOS for patients who were admitted to the
PICU or PCICU during their hospital admission. The current
evidence suggests that limiting the use of dornase alfa does not
affect clinical outcomes in patients without cystic fibrosis, and
that other more cost-effective options exist to treat pulmonary
atelectasis and secretions in critically ill patients. Further studies should be conducted to determine the clinical efficacy of
dornase alfa for hospitalized patients without cystic fibrosis.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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