Does nebulized heparin have value in acute respiratory distress syndrome patients in the setting of polytrauma

Abstract

BackgroundSeveral studies have been conducted with anticoagulants in the setting of experimental lung injury in animals and acute respiratory distress syndrome (ARDS) in humans. However, the clinical evidence for pulmonary anticoagulant therapy is still limited.AimWe aimed to assess the value of the use of nebulized heparin in ARDS patients in the setting of polytrauma.Patients and methodsEighty patients admitted with polytrauma and diagnosed to have ARDS and mechanically ventilated were enrolled. Patients were divided randomly into two groups, and each group included 40 patients: group 1 received nebulized heparin at a dose 5000 IU every 4 h, and group 2 served as control. All clinical and laboratory data were recorded. Patients were followed up during their whole ICU stay. All data were statistically analyzed.ResultsThe mean age of the studied patients was 34.35± 14.6 and 34.87±14.86 years in group 1 and group 2, respectively. After 1 week, patients in group 1 had significant improvement in their PO2/FiO2 and lung injury severity score compared with patients in group 2 (231.1±42.7 and 1.82±0.66 vs. 203.6±45.9 and 2.35±0.35, P<0.001, respectively). Group 1 spent less days on mechanical ventilation and their length of ICU stay was lower compared with group 2 (9.6±13.5 and 12.7±4.3 days vs. 13.5±3.1 and 17.7±3.7 days, respectively, P<0.001). Other outcome parameters such as development of multiple organ dysfunction syndrome, the need to use vasoactive agents, and mortality did not differ between both groups (12, 62.5, and 20% vs. 15, 57.5, and 22.5%, P=0.5, 0.41, and 0.61, respectively).ConclusionNebulized heparin may be beneficial and safe but has no survival benefit in ARDS patients in the setting of polytrauma.