Reduction in Mortality in Pediatric Patients with Inhalation Injury with Aerosolized Heparin/Acetylcystine Therapy

Desai, M. H.; Mlcak, Ronald P.; Richardson, James A.; Nichols, Ray J.; Herndon, David N.

doi:10.1097/00004630-199805000-00004

Cited by 205 publications

(115 citation statements)

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“…In the current trial, doses of heparin used were consistent with previous studies in burns, [1] asthma, [30] bronchiectasis [31] and cystic fibrosis. [6] The lack of effect of heparin in this study compared to previous studies may have been due to different patterns of airway inflammation seen in acutely ventilated patients or a low baseline VAP rate.…”

Section: Discussionsupporting

confidence: 80%

“…Unfractionated heparin (UFH) is an inexpensive naturally occurring sulphated glycosaminoglycan [1] which promotes mucociliary clearance [2], decreases sputum viscidity, [2] displays antibacterial effects on common respiratory pathogens, [3] and has anti-inflammatory properties. [4] Clinical applications have been reported in airway burns [5] and respiratory conditions where there is a significant sputum production or airway inflammation.…”

Section: Introductionmentioning

confidence: 99%

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Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

Bandeshe

Dulhunty

Dunlop

et al. 2016

Journal of Critical Care

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Word Length: 242Word length excluding abstract, tables and references: 2654 Keywords: nebulization, ventilator associated complication, ventilator associated pneumonia, unfractionated heparin, Corresponding Author:Associate Professor Rob Boots Department of Intensive Care Medicine Royal Brisbane and Women's HospitalButterfield Street, Herston.Queensland. AUSTRALIA. 4029Email: r.boots@uq.edu.au Udy, Andrew BHB MB ChB PGCert(AME) FCICM PhD 6 White, Hayden FCICM 7 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTA C C E P T E D M A N U S C R I P T Conclusion:Nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

Bandeshe

Dulhunty

Dunlop

et al. 2016

Journal of Critical Care

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“…The results from this single-center study suggest that 5,000 units of aerosolized heparin alternating with 3 mL of 20% N-acetylcysteine every 2 h for the first 7 d of injury lessen the need for re-intubation, ventilator time, and mortality in pediatric burn subjects. 13 An RCT of 20 male subjects with chronic bronchitis or asthmatic bronchitis comparing aerosolized N-acetylcysteine and isoproterenol reported decreased sputum viscosity (subjectively assessed), but no significant change in pulmonary function or daily sputum volume. 14 The lack of high-level evidence from the studies included in this review does not support a recommendation for these therapies.…”

Section: Hospitalized Adult and Pediatric Patients Without Cystic Fibmentioning

confidence: 99%

“…56,57 As mucoregulatory agents, anticholinergic medications may reduce mucus secretion, but the evidence demonstrates no improvement in mucus clearance in patients with or without pulmonary disease. 13 Some mucoactive medications improve mucus clearance when used in patients with CF, but the evidence does not support the use of these medications for patients with non-CF pulmonary disease. [58][59][60][61] Novel therapies to improve mucus clearance in unique situations, such as burns and inhalation injuries, have shown promise, but the amount of evidence is small, and more investigation is necessary before making definitive recommendations.…”

Section: Implications and Directions For Future Researchmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.

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“…The use of nebulized heparin and acetylcysteine reduces the need for reintubation, as well as the incidence of atelectasis and mortality. (9) Antibiotics are indicated whenever there are signs of infection. Corticosteroids are not routinely indicated and should be used only in cases of bronchospasm that is unresponsive to the initial measures.…”

mentioning

confidence: 99%

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

et al. 2009

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Objective: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. Methods: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. Results: Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. Conclusions: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns. (44,7 vs. 31,5 anos). A superfície corporal queimada foi em média de 60,1% nos pacientes que morreram e de 26,1% nos sobreviventes (p < 0,0001). Entre os 18 pacientes submetidos à broncoscopia, 11 (61,1%) apresentaram sinais endoscópicos de lesão por inalação de fumaça, e 4 (36,4%) destes faleceram. Dos 7 pacientes sem sinais de lesão por inalação de fumaça, 4 (57,1%) faleceram. A média do número de células epiteliais ciliadas no LBA dos pacientes que morreram foi significativamente maior daquela dos sobreviventes (6,6% vs. 1,4%; p = 0,03). Os demais parâmetros analisados não mostraram diferença entre os grupos. Conclusões: A superfície corporal queimada mostrou ser um fator preditivo de mortalidade. O aumento do número de células epiteliais ciliadas no LBA, denotando descamação epitelial brônquica, esteve associado à maior mortalidade de pacientes com queimaduras faciais.Descritores: Queimaduras; Lesão por inalação de fumaça; Lavagem broncoalveolar; Células epiteliais brônquicas; Macrófagos; Fator de necrose tumoral alfa.

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Reduction in Mortality in Pediatric Patients with Inhalation Injury with Aerosolized Heparin/Acetylcystine Therapy

Cited by 205 publications

References 0 publications

Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

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