Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial.
Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial.
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DOI：
10.1186/cc9286
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Campbell DJ
中科院分区：
文献类型：
--
作者：
Dixon B;Schultz MJ;Smith R;Fink JB;Santamaria JD;Campbell DJ
长期机械通气有可能加重或引发肺部炎症，并通过纤维蛋白沉积引起肺损伤。肝素可减少肺部炎症和纤维蛋白沉积。因此，我们评估了雾化肝素是否改善了预期需要长期机械通气的患者的肺功能。50例预计需要机械通气超过48小时的患者入组了一项双盲随机安慰剂对照试验，根据患者身高，每4或6小时雾化肝素（25，000 U）或安慰剂（生理盐水）。在患者保持通气的同时，继续研究药物给药，直至随机化后最多14天。雾化肝素与主要终点（机械通气时平均每日氧分压与吸入氧分数之比）的显著改善无关，但与次要终点（第28天存活者无呼吸机天数）的改善相关（22.6 ± 4.0 vs 18.0 ± 7.1，治疗差异4.6天，95% CI 0.9 - 8.3，P = 0.02）。肝素给药与任何不良事件的增加无关。对于预计需要长期机械通气的重症患者，雾化肝素与机械通气天数减少有关。需要进一步的试验来证实这些发现。澳大利亚临床试验登记处（ACTR-12608000121369）。
Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulized heparin improved lung function in patients expected to require prolonged mechanical ventilation. Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomized placebo-controlled trial of nebulized heparin (25,000 U) or placebo (normal saline) 4 or 6 hourly, depending on patient height. The study drug was continued while the patient remained ventilated to a maximum of 14 days from randomization. Nebulized heparin was not associated with a significant improvement in the primary end-point, the average daily partial pressure of oxygen to inspired fraction of oxygen ratio while mechanically ventilated, but was associated with improvement in the secondary end-point, ventilator-free days amongst survivors at day 28 (22.6 ± 4.0 versus 18.0 ± 7.1, treatment difference 4.6 days, 95% CI 0.9 to 8.3, P = 0.02). Heparin administration was not associated with any increase in adverse events. Nebulized heparin was associated with fewer days of mechanical ventilation in critically ill patients expected to require prolonged mechanical ventilation. Further trials are required to confirm these findings. The Australian Clinical Trials Registry (ACTR-12608000121369).
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DOI：
10.1186/cc8230
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Determann RM;Royakkers A;Wolthuis EK;Vlaar AP;Choi G;Paulus F;Hofstra JJ;de Graaff MJ;Korevaar JC;Schultz MJ
通讯作者：
Schultz MJ
DOI：
10.1152/ajplung.00268.2007
发表时间：
2008-02-01
影响因子：
4.9
作者：
Determann, Rogier M.;Wolthuis, Esther K.;Schultz, Marcus J.
通讯作者：
Schultz, Marcus J.
影响因子：
38.9
作者：
Dixon, Barry;Campbell, Duncan J.;Santamaria, John D.
通讯作者：
Santamaria, John D.
DOI：
10.1089/jamp.2009.0779
发表时间：
2010-04-01
影响因子：
3.4
作者：
Hofstra, Jorrit J.;Vlaar, Alexander P.;Schultz, Marcus J.
通讯作者：
Schultz, Marcus J.
影响因子：
8.8
作者：
Gajic, O;Dara, SI;Hubmayr, RD
通讯作者：
Hubmayr, RD