الفهرس 
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Abstract
This study was conducted on 50 ICU patients who were in need for mechanical ventilation for more than 48 hours; they were selected and grouped randomly as the following: group І: They were given nebulized heparin sodium until weaning or for a maximum 14 days. group ІІ : They were set as a comparative group.
Patient with coagulopathy or intended for any invasive intervention that may lead to bleeding was excluded also, patients weaned or died before day four from admission. Both groups were followed up for 28 days.
Heparin sodium at a dose of 25,000 U/5 mL was given by nebulization to group I in the inspiratory limb of the mechanical ventilator before the Y-piece every 4 hours.
Study medication was intended to be continued with a dose regimen of every 6 hours if therapeutic anti-coagulation is commenced. No dose adjustment was made for heparin administration for deep venous thrombosis prophylaxis.
The study medication was intended to be reduced or withheld if any significant bleeding occurred. The end point results were primary the oxygenation parameters (mainly PaO2/FIO2) and the ventilator free days. All other data were recorded and analyzed (at day one and four) to find out the adverse /positive effect for heparin nebulization. The two groups were not so comparable at baseline at many parameters so direct comparison between the two groups at day 4 from admission was avoided whenever possible. Data were obtained and analyzed statistically, revealing the following:
All the following data showed no statistically significant change at day four within the same group or when comparing the percent change between the two groups:
PH, PaCO2, PaO2, HCO3, SO2, PaO2/FIO2, FIO2 X Mean airways pressure/ PaO2, peak inspiratory pressure, mean airways pressure, tumor necrosis factor α level in non-bronchoscopic lavage, systolic blood pressure, diastolic blood pressure, hemoglobin, hematocrit value, white blood cells count, platelet count, prothrombin concentration, international normalized ratio, presence of bloody sputum, ICU stay free days at day 28, ventilator free days at day 28, presence of acute renal failure at day 28, vasopressor free days at day 28, mortality at day 28 and sputum culture results at day four.
The following data showed a statistically significant change:
Plateau pressure:
It showed a statistically significant decrease in group I when comparing day one and day four within the same group and when we compared the percent change in each group with each other.
Compliance:
It showed a statistically significant increase in group I only when comparing day one and day four within the same group but when we compared the percent change in each group with each other, this change was not statistically significant. aPTT:
Its value showed a statistically significant increase in group I only when comparing day one and day four within the same group but when we compared the percent change in each group with each other, this change was not statistically significant.
Complication of the used drug:
No cases of heparin-induced thrombocytopenia were noted in the tested group and no major bleeding or need for blood transfusion related to the tested medication in this group.