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

Summary

In adults with smoke inhalation injury, early nebulized heparin (5000 IU q4h) increased ventilator-free days and ICU-free days and accelerated weaning from mechanical ventilation compared with placebo, after adjustment for burn area and timing.

Key Findings

• Randomized 88 adults within 24 hours of smoke inhalation injury to nebulized heparin 5000 IU q4h vs saline for up to 14 days.
• Inhaled heparin increased ventilator-free days at 28 days after adjustment (P=0.046).
• Higher cumulative incidence of weaning from mechanical ventilation over time with heparin (P=0.007).
• More ICU-free days in the heparin group (P=0.015).

Clinical Implications

Consider early inhaled heparin protocols for smoke inhalation injury to enhance ventilator weaning and reduce ICU burden, with individualized assessment of bleeding risk and multidisciplinary implementation.

Limitations

• Single-center, modest sample size; blinding and adverse event details (e.g., bleeding) are not reported in the abstract.
• Outcome reporting on oxygenation indices is truncated in the abstract, limiting interpretation.

Future Directions

Larger, multicenter RCTs to confirm efficacy and safety (including bleeding risk), define optimal dosing and duration, and explore effects on mortality and ventilator-associated complications.