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A trial of nebulised heparin to limit lung injury following cardiac surgery

Version 2 2024-06-04, 06:07
Version 1 2018-09-10, 14:26
journal contribution
posted on 2024-06-04, 06:07 authored by B Dixon, R Smith, JD Santamaria, Neil OrfordNeil Orford, BJ Wakefield, K Ives, R McKenzie, B Zhang, Cheng-Hon YapCheng-Hon Yap
Cardiac surgery with cardiopulmonary bypass triggers an acute inflammatory response in the lungs. This response gives rise to fibrin deposition in the microvasculature and alveoli of the lungs. Fibrin deposition in the microvasculature increases alveolar dead space, while fibrin deposition in alveoli causes shunting. We investigated whether prophylactic nebulised heparin could limit this form of lung injury. We undertook a single-centre double-blind randomised trial. Forty patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomised to prophylactic nebulised heparin (50,000 U) or placebo. The primary endpoint was the change in arterial oxygen levels over the operative period. Secondary endpoints included end-tidal CO2, the alveolar dead space fraction and bleeding complications. We found nebulised heparin did not improve arterial oxygen levels. Nebulised heparin was, however, associated with a lower alveolar dead space fraction ( P <0.05) and lower tidal volumes at the end of surgery ( P <0.01). Nebulised heparin was not associated with bleeding complications. In conclusion, prophylactic nebulised heparin did not improve oxygenation, but was associated with evidence of better alveolar perfusion and CO2 elimination at the end of surgery.

History

Journal

Anaesthesia and intensive care

Volume

44

Pagination

28-33

Location

United States

ISSN

0310-057X

eISSN

1448-0271

Language

English

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2016, Australian Society of Anaesthetists

Issue

1

Publisher

AUSTRALIAN SOC ANAESTHETISTS