Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/acetylcystine therapy

M. H. Desai, R. Mlcak, J. Richardson, R. Nichols, David Herndon

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Smoke-inhalation injury causes a destruction of the ciliated epithelium that lines the tracheobronchial tree. Casts produced from these cells, polymorphonuclear leukocytes and mucus, can cause upper-airway obstruction, contributing to pulmonary failure. We have reported that a combination of aerosolized heparin and a mucolytic agent, acetylcystine, can ameliorate cast formation and reduce pulmonary failure secondary to smoke inhalation. In this study, 90 consecutive pediatric patients between 1985 and 1995 who had bronchoscopically diagnosed inhalation injury requiring ventilatory support were studied. Forty-three children admitted between 1985 and 1989 acted as controls. Forty-seven children admitted between 1990 and 1994 received 5000 units of heparin and 3 ml of a 20% solution of acetylcystine aerosolized every 4 hours the first 7 days after the injury. All patients were extubated when they were able to maintain spontaneously a Pao2/FIO2 ratio of more than 400. The number of patients requiring reintubation for successive pulmonary failure was recorded, as was mortality. The results indicate a significant decrease in reintubation rates, in incidence of atelectasis, and in mortality for patients treated with the regimen of heparin and acetylcystine when compared with controls. Heparin/acetylcystine nebulization in children with massive burn injury and smoke-inhalation injury results in a significant decrease in incidence of reintubation for progressive pulmonary failure and a reduction in mortality.

Original languageEnglish (US)
Pages (from-to)210-212
Number of pages3
JournalJournal of Burn Care and Rehabilitation
Volume19
Issue number3
StatePublished - May 1998

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Inhalation
Heparin
Smoke Inhalation Injury
Pediatrics
Lung
Mortality
Wounds and Injuries
Expectorants
Pulmonary Atelectasis
Incidence
Airway Obstruction
Mucus
Therapeutics
Smoke
Neutrophils
Epithelium

ASJC Scopus subject areas

  • Rehabilitation
  • Surgery
  • Nursing(all)
  • Health Professions(all)
  • Emergency Medicine

Cite this

Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/acetylcystine therapy. / Desai, M. H.; Mlcak, R.; Richardson, J.; Nichols, R.; Herndon, David.

In: Journal of Burn Care and Rehabilitation, Vol. 19, No. 3, 05.1998, p. 210-212.

Research output: Contribution to journalArticle

Desai, M. H. ; Mlcak, R. ; Richardson, J. ; Nichols, R. ; Herndon, David. / Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/acetylcystine therapy. In: Journal of Burn Care and Rehabilitation. 1998 ; Vol. 19, No. 3. pp. 210-212.
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