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A Pilot Study of Nebulized Heparin for Prevention of Ventilator Induced Lung Injury: Comparative Effects With an Inhaled Corticosteroid Publisher



Ghiasi F1 ; Sadeghian M2 ; Emami M1 ; Kiaie B3 ; Mousavi S4
Authors
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Authors Affiliations
  1. 1. Department of Pulmonology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Internal Medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Department of Anesthesiology and Intensive Care, Anesthesiology and Critical Care Research Center, Isfahan, Iran
  4. 4. Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan, Iran

Source: Indian Journal of Critical Care Medicine Published:2017


Abstract

Background: Ventilator-induced lung injury (VILI) is a side effect of mechanical ventilation. Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses anti-inflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI. Methods: Sixty critically ill adult patients who require mechanical ventilation for more than 48 h were included in this prospective, nonrandomized controlled study. Patients received nebulized heparin (10,000 U every 6 h) for 5 days. The matched control group received nebulized budesonide as routine practice in our center. This study assessed changes in partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) and rapid shallow breathing index (RSBI) during the study as primary endpoints. Results: The average daily PaO2/FiO2ratio was not statistically significant between both groups (187 ± 11.6 vs. 171 ± 11.6, P = 0.35). The RSBI also did not differ between groups (P = 0.58). Heparin administration was associated with a higher number of ventilator-free days among survivors but not significantly (7.7 ± 10.6 vs. 5.1 ± 8, 95∗ confidence interval - 2.2-7.5, P = 0.28). Successful weaning from mechanical ventilation was higher in the heparin group (P = 0.42). We did not observe any serious or increased adverse effects from nebulized heparin. Conclusion: The results of this study show that the overall effectiveness of nebulized heparin is at least as comparable with a potent corticosteroid (budesonide). Heparin could be a safe and effective modality for patients who at risk of VILI. © 2017 Indian Journal of Critical Care Medicine Published by Wolters Kluwer - Medknow.
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