title: Use of Nebulized Heparin, Nebulized N-Acetylcysteine, and Nebulized Epoprostenol in a Patient With Smoke Inhalational Injury and Acute Respiratory Distress Syndrome.
abstract: Smoke inhalation injury (SIJ) is associated with an increase in morbidity and mortality in patients with burns. SIJ causes airway damage, inflammation, and bronchial obstruction, resulting in decreased oxygenation and perfusion status in these patients. Retrospective studies have compared the use of nebulized heparin (NH) plus nebulized N-acetylcysteine (NAC) and albuterol in patients with SIJ to those who received standard ventilator support with bronchodilator therapy. These studies are associated with a decrease in mortality when NH and nebulized NAC are administered to patients with SIJ. Approximately 20% of patients who develop SIJ will also develop acute respiratory distress syndrome (ARDS). Epoprostenol, a selective pulmonary vasodilator, has been utilized in the treatment of ARDS with mixed results for improving gas exchange. To our knowledge, this is the first case report of the concomitant administration of NH, nebulized NAC, and nebulized epoprostenol following SIJ in a burn patient with ARDS.
authors.affiliation: 1 Department of Pharmacy, PGY-2 Critical Care Pharmacy Resident, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Dube
authors.affiliation: 2 Department of Pharmacy, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Ditch
authors.affiliation: 3 Respiratory Department, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Luanne
authors.initials: L
authors.lastname: Hills
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000280:Administration, Inhalation; D000925:Anticoagulants / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage*; D005100:Expectorants / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015208:Smoke Inhalation Injury / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D005100:Expectorants; D006493:Heparin; D011464:Epoprostenol; D000111:Acetylcysteine
keywords: ARDS; anticoagulation; burns; critical care; epoprostenol; heparin; pulmonary