Effect of early administration of inhaled heparin on outcomes of smoke inhalation injury: A randomized controlled trial.

Abstract

The present study aimed to examine the effects of early administration of inhaled heparin on the outcome of smoke inhalation injury. Eighty-eight adults suffering smoke inhalation injury within 24 h were randomized to receive 5000 IU of heparin (n = 44) or normal saline (n = 44) by nebulization every 4 h until successful extubation or death, up to a maximum of 14 days. The primary outcome was ventilator-free days (VFDs) and alive at 28 days. The secondary outcomes included the intensive care unit (ICU)-free days and alive at 28 days, change in the PaO₂/FiO₂ ratio, 28-day all-cause mortality rate, and mechanical ventilation days in survivors. When adjusted to the burn area and burn-to-randomization time, inhaled heparin was associated with more VFDs (P =.046) and a higher cumulative incidence of weaning from mechanical ventilation over time (P =.007). Patients receiving inhaled heparin had more ICU-free days (P =.015), higher PaO₂/FiO₂ ratio (P =.001), and fewer mechanical ventilation days in survivors (P <.001), but the mortality rate was comparable to the control group (P =.596). The early administration of inhaled heparin to patients suffering smoke inhalation injury was associated with more VFDs and enhanced weaning from mechanical ventilation. Inhaled heparin was also associated with more ICU-free days, higher PaO₂/FiO₂ ratios, and fewer mechanical ventilation days in survivors. Larger randomized controlled trials are required to establish the role of inhaled heparin as a standard of care in this clinical setting.