PURPOSE: Inhalational lung injury (ILI) increases the incidence of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in burn patients. Nebulized heparin (NH) and N-acetylcysteine (NA) [(NH-NA)] have been shown to decrease morbidity and mortality in both sheep models and pediatric patients. In this study, we investigated the potential benefits of NH-NA in adult patients with ILI.
METHODS: We reviewed the records of all mechanically ventilated adult subjects admitted to our burn unit over a one-year period with a diagnosis of ILI confirmed by bronchoscopy and treated with NH-NA (NH-NA group). We calculated APACHE-III scores on admission in addition to daily Lung Injury Score (LIS) for seven days. LIS was determined by averaging the scores of chest roentgenogram, PaO2/FiO2, PEEP, and respiratory system compliance. The NH-NA group was divided into five APACHE-III subgroups and matched with ILI patients who were treated in our burn unit over a four-year period before the initiation of NH-NA protocol (Non-NH-NA).
RESULTS: Nine patients in the NH-NA group and seven in the Non-NH-AC group met our inclusion and exclusion criteria and had APACHE III score greater than 35 (mean 46.66 vs. 44.86, p=0.38). In the first two ICU days mean LIS were 0.76±0.53 vs. 1.23±0.88 (p=0.08) for NH-NA and Non-NH-NA patients respectively. Mean LIS during the first week were 0.91±0.14 vs. 1.79±0.41, (p<0.01) for NH-NA and Non-NH-NA patients respectively. In addition, 11% (1/9) of the patients in NH- NA group and 43% (3/7) patients in the Non-NH- NA group died during the first ICU week.
CONCLUSION: Nebulized heparin and N-acetylcysteine reduced lung injury scores in adult burn patients with smoke inhalation injury and high APACHE III scores during the first week of treatment.
CLINICAL IMPLICATIONS: These results support the previously reported benefits of NH-AC in patients with ALI/ARDS after ILI and highlight the need to start NH-AC therapy as early as possible after ILI. Our final report will shade light on the role of the NH-AC treatment in ILI patients with lower APACHE-III scores.
DISCLOSURE: Abel Rivero, No Financial Disclosure Information; No Product/Research Disclosure Information