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

Hiran Bandeshe, Rob Boots, Joel Dulhunty, Rachael Dunlop, Anthony Holley, Paul Jarrett, Charles D. Gomersall, Jeff Lipman, Thomas Lo, Steven O'Donoghue, Jenny Paratz, David Paterson, Jason A. Roberts, Therese Starr, Di Stephens, Janine Stuart, Jane Thomas, Andrew Udy, Hayden White

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Abstract

Purpose: 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.

Original languageEnglish
Pages (from-to)95-102
Number of pages8
JournalJournal of Critical Care
Volume34
DOIs
Publication statusPublished - Aug 2016
Externally publishedYes

Keywords

  • Nebulization
  • Unfractionated heparin
  • Ventilator associated complication
  • Ventilator associated pneumonia

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