Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?

IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group, Inhaled Heparin Investigators, 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, Hayden White

The purpose was to determine the efficacy of prophylactic inhaled heparin for the prevention and treatment of pneumonia in patients receiving mechanical ventilation (MV). A phase 2, double-blind, randomized controlled trial stratified for study center and patient type (nonoperative, postoperative) was conducted in 3 university-affiliated intensive care units. Patients aged at least 18 years and requiring invasive MV for more than 48 hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 U in 2 mL), or nebulization with 0.9% sodium chloride (2 mL) 4 times daily with the main outcome measures, the development of ventilator-associated pneumonia (VAP), ventilator-associated complication, and Sequential Organ Failure Assessment scores in patients with admission pneumonia or developing VAP. ACTRN12612000038897. A total of 214 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=.85). Low-dose nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.