Inhalation/intravenous recombinant tissue plasminogen activator and inhaled heparin in a patient with acute respiratory distress syndrome

Abstract

Recent studies have demonstrated that lung fibrin deposits are associated with evolution of acute respiratory distress syndrome (ARDS). A young woman with ARDS resistant to conventional treatment was treated with ultrasonic nebulized rt-PA (30 mg) and intravenous rt-PA (20 mg) over 2 h followed by continuous treatment with ultrasonic nebulized unfractionated heparin (15 000 IU/day). The pulmonary gas exchange of the patient improved significantly and the condition of the patient stabilized during the hours following the fibrinolytic treatment. The potential use of nebulized thrombolytics for local treatment of ARDS is discussed, and we conclude that combined nebulized and intravenous therapy with thrombolytics may improve physiologic derangements associated with acute lung injury in ARDS.