Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?. The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group

Bandeshe, Hiran, Boots, Rob, Dulhunty, Joel, Dunlop, Rachael, Holley, Anthony, Jarrett, Paul, Gomersall, Charles D., Lipman, Jeff, Lo, Thomas, O'Donoghue, Steven, Paratz, Jenny, Paterson, David, Roberts, Jason A., Starr, Therese, Stephens, Di, Stuart, Janine, Thomas, Jane, Udy, Andrew and White, Hayden (2016) Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?. The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group. Journal of Critical Care, 34 95-102. doi:10.1016/j.jcrc.2016.04.005


Author Bandeshe, Hiran
Boots, Rob
Dulhunty, Joel
Dunlop, Rachael
Holley, Anthony
Jarrett, Paul
Gomersall, Charles D.
Lipman, Jeff
Lo, Thomas
O'Donoghue, Steven
Paratz, Jenny
Paterson, David
Roberts, Jason A.
Starr, Therese
Stephens, Di
Stuart, Janine
Thomas, Jane
Udy, Andrew
White, Hayden
Title Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?. The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group
Journal name Journal of Critical Care   Check publisher's open access policy
ISSN 1557-8615
0883-9441
Publication date 2016-08-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.jcrc.2016.04.005
Open Access Status Not Open Access
Volume 34
Start page 95
End page 102
Total pages 8
Place of publication Maryland Heights, MO, United States
Publisher W.B. Saunders
Collection year 2017
Language eng
Formatted abstract
Purpose: To determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit.

Methods: A phase 2, double blind randomized controlled trial stratified for study center and patient type (non-operative, post-operative) was conducted in three university-affiliated intensive care units. Patients aged ≥. 18 years and requiring invasive MV for more than 48 hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2 mL) or placebo nebulization with 0.9% sodium chloride (2 mL) four times daily with the main outcome measures of the development of ventilator associated pneumonia (VAP), ventilator associated complication (VAC) and sequential organ failure assessment scores in patients with pneumonia on admission or who developed VAP. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12612000038897.

Results: Two hundred and fourteen patients were enrolled (72 usual care, 71 inhaled sodium heparin, 71 inhaled sodium chloride). There were no differences between treatment groups in terms of the development of VAP, using either Klompas criteria (6-7%, P = 1.00) or clinical diagnosis (24-26%, P = 0.85). There was no difference in the clinical consistency (P = 0.70), number (P = 0.28) or the total volume of secretions per day (P = .54). The presence of blood in secretions was significantly less in the usual care group (P = 0.005).

Conclusion: Nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.
Keyword Nebulization
Unfractionated heparin
Ventilator associated complication
Ventilator associated pneumonia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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