Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?

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?. Journal of Critical Care, 35 231-239. doi:10.1016/j.jcrc.2016.06.022

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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?
Journal name Journal of Critical Care   Check publisher's open access policy
ISSN 0883-9441
Publication date 2016-10-01
Sub-type Article (original research)
DOI 10.1016/j.jcrc.2016.06.022
Open Access Status File (Author Post-print)
Volume 35
Start page 231
End page 239
Total pages 9
Place of publication Maryland Heights, MO, United States
Publisher W. B. Saunders
Collection year 2017
Language eng
Formatted abstract
Purpose: The purpose was to determine the efficacy of prophylactic inhaled heparin for the prevention and treatment of pneumonia in patients receiving mechanical ventilation (MV).

Methods: A phase 2, double-blind, randomized controlled trial stratified for study center and patient type (nonoperative, postoperative) was conducted in 3 university-affiliated intensive care units. Patients aged at least 18 years and requiring invasive MV for more than 48 hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 U in 2 mL), or nebulization with 0.9% sodium chloride (2 mL) 4 times daily with the main outcome measures, the development of ventilator-associated pneumonia (VAP), ventilator-associated complication, and Sequential Organ Failure Assessment scores in patients with admission pneumonia or developing VAP. Trial registration: ACTRN12612000038897.

Results: A total of 214 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 = .85).

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

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