Effect of Nebulized Heparin in Prevention of Ventilator-Induced Lung Injury

Patients who were been under mechanical ventilation for more than 48 hours are susceptible to ventilator-induced lung injury (VILI). Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses antiinflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI.

Sixty critically ill adult patients who require mechanical ventilation for more than 48 hours were included in this prospective, nonrandomized controlled study. Patients received nebulized heparin (10000 U every 6 hours) 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 period as primary endpoints.

The average daily PaO2/FiO2 ratio was not statistically significant between both groups (187±11.6 versus 171±11.6, P: 0.35). The RSBI also didn’t 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 versus 5.1±8, 95% CI -2.2 to 7.5, P: 0.28). Successful weaning from mechanical ventilation was higher in the heparin group (P: 0.42). We didn’t observe any serious or increased adverse effects from nebulized heparin.

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.