Nebulized Heparin in Burn Patients with Inhalation Trauma—Safety and Feasibility
Open Access
- 25 March 2020
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 9 (4), 894
- https://doi.org/10.3390/jcm9040894
Abstract
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.Funding Information
- Nederlandse Brandwonden Stichting (12.001)
This publication has 21 references indexed in Scilit:
- Nebulized heparin for patients under mechanical ventilation: an individual patient data meta-analysisAnnals of Intensive Care, 2016
- HEPBURN - investigating the efficacy and safety of nebulized heparin versus placebo in burn patients with inhalation trauma: study protocol for a multi-center randomized controlled trialTrials, 2014
- Inhaled Anticoagulation Regimens for the Treatment of Smoke Inhalation–Associated Acute Lung InjuryCritical Care Medicine, 2014
- The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury*Critical Care Medicine, 2012
- Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trialCritical Care, 2010
- Pathophysiology, management and treatment of smoke inhalation injuryExpert Review of Respiratory Medicine, 2009
- Use of Inhaled Heparin/N-acetylcystine in Inhalation Injury: Does it help?Journal of Burn Care & Research, 2008
- National Burn Repository 2006: A Ten-Year ReviewJournal of Burn Care & Research, 2007
- Pathophysiological Basis of Smoke Inhalation InjuryPhysiology, 2003
- Etiology and consequences of respiratory failure in thermally injured patientsThe American Journal of Surgery, 1993