Effect of Nebulized Heparin on Weaning off Intubated Patients with Acute Respiratory Distress Syndrome (ARDS) Admitted to Intensive Care Unit (ICU): A Randomized Clinical Trial

Abstract

Background: Acute respiratory distress syndrome (ARDS) treatment is based on supportive care such as mechanical ventilation, prophylaxis of stress ulcer, prophylaxis of deep vein thrombosis (DVT), nutritional support, and treatment of underlying disease. Objectives: We aimed to investigate the effects of nebulized heparin on weaning off intubated ARDS patients admitted to the intensive care unit (ICU). Methods: In this double-blind clinical trial study, 60 patients with ARDS receiving routine care according to the ARDS protocol were randomly assigned into two groups: intervention group (receiving nebulized heparin 5000 u/BD for one week) and control group (receiving nebulized sterile water 2 cc/BD for one week). The respiratory index (PaO2/FiO2), pulmonary shunt percentage (measured by ABG), tidal volume, minute ventilation, admission duration in the ICU, and days of mechanical ventilation required were recorded for each patient for one week. Results: There was no significant difference in demographic data between the two groups. Inhaled heparin in patients with ARDS could significantly increase the respiratory index (PaO2/FiO2) and decrease pulmonary shunt percentage, minute ventilation, and tidal volume. It also significantly reduced the number of admission days in the ICU and the need for mechanical ventilation. Conclusions: The result of the present study showed that inhaled heparin in intubated ARDS patients admitted to the ICU improved respiratory and pulmonary status and reduced the need for mechanical ventilation and admission days in the ICU. Nebulizing heparin, as an anti-inflammatory and anti-coagulant agent, is an effective and safe medication for ARDS patients on mechanical ventilation.

The Efficacy of Daily Administration of Nebulized Heparin on the Prevention of Endotracheal Tube Blockage in Patients With Pneumonia

“…Meanwhile, among the two groups given normal saline and heparin, we did not discover a statistically significant difference in patient's time in the intensive medical unit. This discovery contradicts the findings that Olapour et al [ 26 ] reported. This discrepancy may have its root cause in the small sample size.…”

The effect of nebulized heparin on clinical outcomes in mechanically ventilated patients: a meta-analysis and review of the literature

“…The characteristics of the included studies are summarized in Table 3 . 6 , 7 , 14 – 19 All studies were prospective randomized parallel-group controlled trials involving a total of 651 patients on mechanical ventilation (329 [intervention group] and 322 [control group]). A total of four of the eight studies were conducted in Australia and one each in Ireland, Iran, Netherlands, and Egypt.…”

“…Heparin may improve clinical outcomes by reducing fibrin deposition in the lungs, 20 and it also inhibits adhesion of bacteria and viruses on the respiratory surface, thereby, inhibiting their growth in the lungs. 17 , 20 However, the results of some studies showed no significant effect of inhaled heparin on the duration of ICU stay, which may be due to heterogeneity of the studies. The population of these studies mainly consisted of patients with airway burns, 18 , 21 while some were non-RCT studies, and their findings need further validation.…”

Evaluating the Efficacy of the National Early Warning Score in Predicting the Mortality of Stroke Patients Admitted to Intensive Care Units

“…CVA is a vascular lesion that causes a neurological deficit and begins acutely and lasts over 24 hours (3). To diagnose CVA and find its causes and rule out other disorders similar to stroke, a number of evaluations such as electrocardiogram (ECG), computed tomography (CT) scan, magnetic resonance imaging (MRI), echocardiography, angiography, and Doppler sonography can be performed (4,5). In addition to causing death, strokes cause disability of the patient throughout life, which can be in the form of various movement, sensory, verbal, memory, visual, etc.…”