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

Abstract

Background: Ventilator-induced lung injury Wail is a side effect of mechanical ventilation. Lung inflammation and pulmonary activation of coagulation are induced by mechanical Clinical and preclinical studies show Mat heparin possessesanti-inliammatory properties. Therefore, we assessed the effects of nebulized heparin in VILE. 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/FiO(2),) and rapid shallow breathing index (RSBI) during the study as primary endpoints. Results: The average daily PaO2/FiO(2) ratiowas 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. 5.1I +/- 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 rbudesonido. Heparin could be a safe and effective modality for patients who at risk of VILI.