Nebulized Heparin With <i>N</i>-Acetylcysteine and Albuterol Reduces Duration of Mechanical Ventilation in Patients With Inhalation Injury

McGinn, Kaitlin; Weigartz, Katie; Lintner, A; Scalese, Michael J.; Kahn, S.

doi:10.1177/0897190017747143

Cited by 26 publications

(21 citation statements)

References 18 publications

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“…In a further pharmacologic attempt to attenuate inflammation in ARDS, nebulized heparin has attenuated inflammation and reduced damage in a preclinical model of ALI [107]. Recently, nebulized heparin, in combination with N-acetylcysteine and albuterol sulfate, reduced the time under ventilation for patients with inhalation injury [108].…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

Future Trends in Nebulized Therapies for Pulmonary Disease

McCarthy

González

Higgins

2020

JPM

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Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.

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Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

Future Trends in Nebulized Therapies for Pulmonary Disease

McCarthy

González

Higgins

2020

JPM

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“…There is limited data on the feasibility of heparin nebulization in patients with inhalation trauma, and none of the published retrospective studies reported clearly about treatment adherence [4,[17][18][19][20][21]. The only prospective study available reported that heparin nebulization was not stopped in any of the patients [16].…”

Section: Discussionmentioning

confidence: 99%

Nebulized Heparin in Burn Patients with Inhalation Trauma—Safety and Feasibility

Glas

Horn

Binnekade

et al. 2020

JCM

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Background: Pulmonary hypercoagulopathy is intrinsic to inhalation trauma. Nebulized heparin could theoretically be beneficial in patients with inhalation injury, but current data are conflicting. We aimed to investigate the safety, feasibility, and effectiveness of nebulized heparin. Methods: International multicenter, double-blind, placebo-controlled randomized clinical trial in specialized burn care centers. Adult patients with inhalation trauma received nebulizations of unfractionated heparin (25,000 international unit (IU), 5 mL) or placebo (0.9% NaCl, 5 mL) every four hours for 14 days or until extubation. The primary outcome was the number of ventilator-free days at day 28 post-admission. Here, we report on the secondary outcomes related to safety and feasibility. Results: The study was prematurely stopped after inclusion of 13 patients (heparin N = 7, placebo N = 6) due to low recruitment and high costs associated with the trial medication. Therefore, no analyses on effectiveness were performed. In the heparin group, serious respiratory problems occurred due to saturation of the expiratory filter following nebulizations. In total, 129 out of 427 scheduled nebulizations were withheld in the heparin group (in 3 patients) and 45 out of 299 scheduled nebulizations were withheld in the placebo group (in 2 patients). Blood-stained sputum or expected increased bleeding risks were the most frequent reasons to withhold nebulizations. Conclusion: In this prematurely stopped trial, we encountered important safety and feasibility issues related to frequent heparin nebulizations in burn patients with inhalation trauma. This should be taken into account when heparin nebulizations are considered in these patients.

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“…A therapy consisting of alternating treatment with nebulized heparin, NAC, and albuterol in adult patients with smoke inhalation injuries decreased the mortality and improved the LIS in 1 retrospective study [ 14 ] and reduced the duration of mechanical ventilation in another. [ 15 ] However, another retrospective study by Holt et al [ 16 ] showed no significant difference in mortality, duration of mechanical ventilation, length of stay, or incidence of pneumonia in patients treated with inhaled heparin and NAC.…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective studies showing beneficial effects of nebulized heparin and NAC used either a high-dose (10,000 IU) [ 14 ] or low-dose (5000 IU) [ 1 , 15 ] nebulized heparin regimen. However, a recent prospective randomized study comparing different doses of nebulized heparin in 29 patients with smoke inhalation concluded that the higher dose of 10,000 IU decreased the LIS and duration of mechanical ventilation compared with that in patients treated with a lower dose of 5000 IU.…”

Section: Discussionmentioning

confidence: 99%

Nebulized heparin and N-acetylcysteine for smoke inhalational injury

Ashraf

Bajantri

Roa-Gomez³

et al. 2018

Medicine

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Rationale:Every year, ∼40,000 people suffer burn-related injuries in the United States. Despite recent advances, the odds of dying from exposure to fire, flames, or smoke are one in ∼1500. Smoke inhalation causes injury to the airways via a complex physiological process, and the treatment is mainly supportive. Many recent interventions aim to decrease the formation of fibrin casts, the main cause of airway damage in these patients. Among these, treatment with a combination of nebulized heparin and N-acetylcysteine (NAC) has shown benefit.Patient concerns:We describe the case of a 58-year-old man who presented after smoke inhalation during a fire. Soot was found in the nostrils when he was admitted to our hospital, and after he began coughing up carbonaceous material, he was electively intubated and placed on volume assist control ventilation.Diagnosis:Bronchoscopy on the first day of intensive care confirmed the injury from smoke inhalation and revealed mucosal edema and soot involving the tracheobronchial tree.Interventions and outcomes:Inhaled unfractionated heparin of 10,000 IU in 3 mL of 0.9% normal saline alternating every 2 hours with 3 mL of 20% NAC was started 48 hours after admission and continued for 7 days. Bronchoscopy on the fifth day of intensive care showed significant improvement in airway edema and a resolution of soot.Lessons:On the basis of our experience with this case and limited literature, we posit that nebulized heparin and NAC may be of benefit in patients with inhalational smoke-induced lung injury and mild-to-severe lung injury scores.

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Nebulized Heparin With N-Acetylcysteine and Albuterol Reduces Duration of Mechanical Ventilation in Patients With Inhalation Injury

Abstract: Nebulized heparin in combination with NAC and albuterol was associated with a significant reduction in the duration of mechanical ventilation.

Cited by 26 publications

References 18 publications

Future Trends in Nebulized Therapies for Pulmonary Disease

Future Trends in Nebulized Therapies for Pulmonary Disease

Nebulized Heparin in Burn Patients with Inhalation Trauma—Safety and Feasibility

Nebulized heparin and N-acetylcysteine for smoke inhalational injury

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