Role of nebulized heparin in mechanically ventilated critically ill patients

Background Mechanical ventilation is a technique for supporting or substituting respiration. Fibrin deposition in the pulmonary microcirculation and alveolar sacs (hyaline membrane generation) is a major inflammatory route of lung injury, as it hinders both alveolar perfusion and ventilation. Heparin lowers fibrin deposition in the lungs and improves clinical outcomes in mechanically ventilated patients, according to clinical and experimental studies. Heparin nebulization may be more efficient than systemic delivery. Aim The purpose of this study was to evaluate how nebulized heparin affected both morbidity and mortality rates in mechanically ventilated patients. Patients and methods A total of 50 patients who required mechanical ventilation for more than 48 h were assigned into two groups: group 1 (control group) received 0.9% nebulized saline and group 2 (treatment group) received nebulized heparin. All patients were subjected to complete history taking, complete physical examination, routine laboratory investigations, daily arterial blood gas analysis and chest imaging, and Sequential Organ Failure Assessment score every 48 h. The primary end point was to evaluate lung functions such as airway resistance, static compliance, hypoxic index, and ventilator-free days. The development of acute respiratory distress syndrome after enrollment, tracheostomy rate, vasopressor-free days, length of ICU stay, and mortality rate at days 7 and 28 were all secondary end points. Results On days 2, 3, 4, 5, and 7, the mean static compliance in the treatment group was considerably higher than in the control group, with a statistically significant difference at days 2 and 4. The mean hypoxic index in the nebulized heparin group was significantly higher than in the control group. The nebulized heparin group had significantly more days without using vasopressors than the control group. Conclusion In patients needing mechanical ventilation for more than 48 h, nebulized heparin significantly improved lung static compliance and hypoxic index and was associated with more vasopressor-free days.