Thursday March 5, 2009
Influence of Nebulized Unfractionated Heparin and N-Acetylcysteine in Acute Lung Injury after Smoke Inhalation Injury

Andrew Miller did an interesting study to see effect of addition of nebulized unfractionated heparin, and NAC in lung injury after smoke inhalation. They studied 30 mechanically ventilated adult subjects who were admitted within 48 hours of their bronchoscopy confirmed smoke inhalation injury over a 5-year period.

The experimental group was treated with nebulized heparin sulfate, N-acetylcystine, and albuterol sulfate. Controls received ventilation support and albuterol sulfate. The authors calculated acute physiology and chronic health evaluation (APACHE)-III scores on admission in addition to daily LIS for 7 days.

The experimental group showed significant improvement in (Lung Injury Scores) LISs, respiratory resistance and compliance measurements, and hypoxia scores as compared with controls throughout the duration of the study. There was a statistically significant survival benefit in the experimental group that was most pronounced in patients with APACHE-III scores more > 35. Survival for the control vs. experimental group was 0.5714 ± 0.1497 vs. 0.9375 ± 0.0605, respectively, (risk ratio -0.0055; 95% confidence interval -0.0314-0.0204; hazard ratio 1.003; number needed to treat 2.7)

Conclusion: The use of aerosolized unfractionated heparin and N-acetylcystine attenuates lung injury and the progression of acute respiratory distress syndrome in ventilated adult patients with acute lung injury following smoke inhalation.


Reference:

Miller A, Rivero A, Zaid S, Smith D, Elamin E. Influence of Nebulized Unfractionated Heparin and N-Acetylcysteine in Acute Lung Injury after Smoke Inhalation Injury. Journal of Burn Care & Research:Volume 2009; 30(2): 249-256