الفهرس 
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Abstract
Acute respiratory distress syndrome (ARDS) is a frequently occurring complication in critically ill patients. These conditions may be triggered by direct insults to the lungs, such as pneumonia or inhalation injury, but can also occur secondary to a systemic situation (e.g. severe sepsis or shock) . Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are characterized by profound imbalances between activation of coagulation and inhibition of fibrinolysis which favors fibrin formation and excessive intra-alveolar fibrin deposition, driven, at least in part by inflammation.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with high mortality rates despite therapeutic advances . In addition, emerging evidence suggests that the use of anticoagulants, such as tissue factor pathway inhibitor, antithrombin, thrombomodulin, heparin, activated protein C, and fibrinolytics (plasminogen activators and particularly tissue plasminogen activator), may be useful in the treatment of ALI and ARDS
This study was designed to test the hypotheses that, High pulmonary concentrations of an anticoagulant or fibrinolytics may be necessary to have an effect on pulmonary coagulation, which may not be achievable with intravenous administration . so Local administration of anticoagulants or profibrinolytics through nebulisation, may allow higher pulmonary concentrations.
We enrolled 40 adult patients with acute respiratory distress syndrome divided into two equal groups each included 20 patients, group I received heparin nebulization , group II received streptokinase nebulization , we compared both groups as regards primary outcome such as, Pa o2 [arterial partial pressure of oxygen], Fio2 [Fraction of inspired oxygen] , Pao2/Fio2 ratio , Lung compliance [ml/cmH2o] and plateau pressure [cmH2o] and secondary outcome such as days free of mechanical ventilation , ICU free days , and discharge rate .
our study showed that administration of streptokinase by nebulization in group II was associated with rapid improvement in lung function as showed by acute increase in Pa o2 and Pao2/Fio2 ratio and increase in lung compliance and deacrease in the plateau pressure .
and that was statistically significant different by comparing it with group I who recived heparin nebulization as Pao2 and Pao2/Fio2 ratio not increased and lung compliance increased but with a degree less than that seen in streptokinase group and the plateau pressure decrease but also with a degree less than that seen in streptokinase group.
By comparing both groups as regarding secondary outcome we found that group II have more days free of mechanical ventilation than group I , discharge rate was higher in group II than group I and number of death was higher in group I than group II .
No stastistically significant difference between the groups as regared bleeding time , prothrombin concentration, APPT and platelet count.
We concluded that administration on streptokinase by nebulization in patient with acute respiratory distress syndrome is associated with rapid improvement in lung function as detected by Pao2 and Pao2/Fio2 ratio and lung compliance . and associated also by more number of ventilator free days , ICU free days .