Nebulized Heparin for Adjunctive Treatment of Mechanically Ventilated Patients in the ICU

摘要

Background: Acute lung injury (ALI) is a serious clinical concern brought on by inflammatory triggers and is characterized by rapid onset of respiratory distress in the setting of inflammatory insult. Fibrin deposition from the inflammation leads to poor ventilation and perfusion. There is no current treatment for ALI other than supportive measures. Heparin is an anticoagulant that prevents fibrin deposition. Previous animal and ALI model studies have demonstrated improvement in lung function markers with nebulized heparin. This review looks at the effects of nebulized heparin in treating ALI in mechanically ventilated patients.Methods: An exhaustive search of available medical literature was performed using MedLine- OVID, CINAHL, and Web of Science. Keywords used included: mechanical ventilation/ respiration, artificial or acute lung injury, and nebulized heparin or nebulised heparin.Results: A total of 11 articles were reviewed for relevancy. Two articles were found including one randomized control study and one prospective observational study. While neither study found improvement in PaO2:FiO2, one study found significant improvement in ventilator free days. The overall quality of the studies was very low and further studies with large, randomized control trials will need to be completed.Conclusion: There isn’t enough data available yet on nebulized heparin to recommend routine use as adjunctive treatment for ALI. Standard lung function markers like PaO2:FiO2 may not be the most useful marker for nebulized heparin trials. Larger, longer randomized control trials need to be completed for further study using patient important outcomes such as ventilator free days.