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Heparin nebulization attenuates acute lung injury with sepsis after smoke inhalation in sheep

Introduction

Fibrin formation in the airway is a common occurrence with acute lung injury. Mucous plugging in the airway prevents alveoli expansion and may increase shunt blood flow. The aim of this study was to investigate the effect of heparin nebulization in acute lung injury (ALI) with sepsis or burn after smoke inhalation in sheep.

Method

Female sheep (n = 20) were used. The animals were divided into two groups. One is an ALI model induced by a combination injury with smoke inhalation and severe pneumonia (n = 10). The other is an ALI model induced by a combination injury with smoke inhalation and 3rd degree 40% body surface area flame burn (n = 10). The preceding groups received 48 breaths of cotton smoke (< 40°C). The sham control animals were not injured, Ps. aeruginosa (5 × 1011 CFU) was inoculated into the airway using a bronchoscope. All the animals were mechanically ventilated after the injury. Burned animals were resuscitated with lactate Ringer's solution following the Parkland formula. Both groups were divided into two. One was treated with heparin nebulization (n = 5; 10,000 U 1 h after the injury and every 4 hours) and the other were treated with the same dose of 0.9% NaCl as a control. Lung histology was scored by a pathologist who was blinded for the animal grouping. Congestion, edema, inflammation, and hemorrhage were scored from 0 (non) to 4 (severe) and total score was calculated (full score = 16).

Results

In sepsis study, the drop in PaO2/FiO2 was significantly attenuated by a heparin while it was not in burn study. The lung histology score was also attenuated by heparin in sepsis but not in burn.

Discussion and conclusion

Heparin nebulization was effective in reducing acute lung injury induced by severe pneumonia and smoke inhalation but not in burn and smoke inhalation. Since heparin does not inhibit thrombin without antithrombin, the result suggests that antithrombin level in the alveolar space, which is exuded from a bronchial blood flow, may be different.

Table 1 Histology score

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Murakami, K., Katahira, J., McGuire, R. et al. Heparin nebulization attenuates acute lung injury with sepsis after smoke inhalation in sheep. Crit Care 5, P062 (2001). https://doi.org/10.1186/cc1129

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Keywords

  • Acute Lung Injury
  • Antithrombin
  • Severe Pneumonia
  • Smoke Inhalation
  • Lung Histology