A Multicenter Evaluation of Outcomes Following the Use of Nebulized Heparin for Inhalation Injury (HIHI2 Study)

Abstract

Inhalation injury causes significant morbidity and mortality secondary to compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with inhalation injury. To date, no study has compared both dosing strategies of 5,000 and 10,000 units to a matched control group. This multicenter, retrospective, case-control study included adult patients with bronchoscopy-confirmed inhalation injury. Each control patient, matched according to age and percent of total body surface area, was matched to a patient who received 5,000 units and a patient who received 10,000 units of nebulized heparin. The primary endpoint of the study was duration of mechanical ventilation. Secondary endpoints included 28-day mortality, ventilator-free days in the first 28 days, difference in lung injury scores, length of hospitalization, incidence of ventilator-associated pneumonia, and rate of major bleeding. Thirty-five matched patient trios met inclusion criteria. Groups were well-matched for age (p = 0.975) and total body surface area (p = 0.855). Patients who received nebulized heparin, either 5,000 or 10,000 units, had 8 to 11 less days on the ventilator compared to controls (p = 0.001). Mortality ranged from 3-14% overall, and was not statistically significant between groups. No major bleeding events related to nebulized heparin were reported. Mechanical ventilation days were significantly decreased in patients who received 5,000 or 10,000 units of nebulized heparin. Nebulized heparin, either 5,000 units or 10,000 units, is a safe and effective treatment for inhalation injury.

Amish Burn Treatment Meets a Major Trauma Centre: Success With Cooperation

“…Burn healing is a complex process which can be delayed at any stage by infection, making topical antimicrobial therapy an important consideration in treatment. 4 The burdock plant is shown to have anti-inflammatory, antimicrobial and analgesic properties, and has been used around the world for the treatment of many conditions for centuries. 5,6 By contrast, the B&W™ Ointment contains many natural ingredients that have been individually studied in wound care, but the ointment itself has not been studied for effectiveness.…”

“…7 Similar to the application of topical antimicrobial agents in modern medicine, local skin reactions resulting from burdock leaves can occur. 4,8 Although fortunately not required in our patient, community elders will often change the dressing material to another type of leaf such as lettuce or plantain to mitigate this reaction. 8 The patient and his community elders anecdotally described the dressing changes as minimally painful and generally very well tolerated.…”

“…Herbal products have been used topically in the care of burn wounds for centuries, and have been shown to stimulate burn wound healing. 4 The use of traditional Amish medicine in the treatment of burn wounds in an academic centre has not been previously described.…”

Acute Burn Care

“…12), 79 and regimens of nebulized heparin and/or N-acetylcysteine have been used to improve pulmonary outcomes. [80][81][82] Those patients with elevated carbon monoxide are treated immediately with 100% oxygen. Hyperbaric oxygen can reduce (or eliminate) carboxyhemoglobin by a factor of five; however, data in the general medical literature provide conflicting results in terms of efficacy compared with standard oxygen therapy.…”