Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?: The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group

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• 作者：Hiran Bandeshe ; MEng^a ; ^b ; Rob Boots ; MB BS ; PhD ; MMedSci ; MHAIT ; FRACP ; FCICM^a ; ^b ; ^{r.boots@uq.edu.au" class="auth_mail" title="E-mail the corresponding author} ; Joel Dulhunty ; MB BS ; MTH ; PhD^a ; ^b ; Rachael Dunlop ; B.Nursing ; GC^a ; ^b ; Anthony Holley ; BSc ; MBBCh ; DipPaeds ; DipDHM ; FACEM ; FCICM^a ; ^b ; Paul Jarrett ; Dip HE^a ; ^b ; Charles D. Gomersall ; BSc ; MBBS ; MRCP(UK) ; FRCA ; EDIC ; FCICM ; FHKCA ; FHKAM ; FRCP (Glasg)^c ; Jeff Lipman ; MBBCh ; DA ; FFA ; FFA(Crit Care) ; FCICM ; MD(Research)^a ; ^b ; Thomas Lo ; BSc ; MSc^c ; Steven O'Donoghue ; MBBS ; FANZCA ; FCICM^a ; ^b ; Jenny Paratz ; PhD ; FACP ; MPhty^a ; ^b ; ^d ; David Paterson ; PhD MBBS FRACP^a ; ^b ; Jason A. Roberts ; PhD ; BPharm(Hons) ; BAppSc ; FSHP^a ; ^b ; Therese Starr ; RN ; NNC ; Grad Cert ; Grad Dip^a ; ^b ; Di Stephens ; OAM ; MBBS ; FANZCA ; FCICM^e ; Janine Stuart ; Cert ; GC^a ; ^b ; Jane Thomas ; BN ; GDip PH ; GCert^e ; Andrew Udy ; BHB MB ChB PGCert(AME) FCICM PhD^f ; Hayden White ; FCICM^g
• 关键词：Nebulization ; Ventilator associated complication ; Ventilator associated pneumonia ; Unfractionated heparin
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：34
• 期：Complete
• 页码：95-102
• 全文大小：508 K

文摘

To determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit.

Methods

A phase 2, double blind randomized controlled trial stratified for study center and patient type (non-operative, post-operative) was conducted in three university-affiliated intensive care units. Patients aged ≥ 18 years and requiring invasive MV for more than 48 hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2 mL) or placebo nebulization with 0.9% sodium chloride (2 mL) four times daily with the main outcome measures of the development of ventilator associated pneumonia (VAP), ventilator associated complication (VAC) and sequential organ failure assessment scores in patients with pneumonia on admission or who developed VAP. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12612000038897.

Results

Two hundred and fourteen 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 = 0.85). There was no difference in the clinical consistency (P = 0.70), number (P = 0.28) or the total volume of secretions per day (P = .54). The presence of blood in secretions was significantly less in the usual care group (P = 0.005).

Conclusion

Nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.