• 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, and Hayden White.
• Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia; Burns Trauma and Critical Care Research Centre, University of Queensland, QLD, Australia.
• J Crit Care. 2016 Aug 1; 34: 95-102.

PurposeTo determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit.MethodsA 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 ≥18years and requiring invasive MV for more than 48hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2mL) or placebo nebulization with 0.9% sodium chloride (2mL) 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 RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000038897.ResultsTwo 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).ConclusionNebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.Copyright © 2016 Elsevier Inc. All rights reserved.

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