REDUCTION IN MORTALITY IN PEDIATRIC-PATIENTS WITH INHALATION INJURY WITH AEROSOLIZED HEPARIN ACETYLCYSTINE THERAPY/

Smoke-inhalation injury causes a destruction of the ciliated epitheliu m that lines the tracheobronchial tree. Casts produced from these cell s, polymorphonuclear leukocytes and mucus, can cause upper-airway obst ruction, contributing to pulmonary failure. We have reported that a co mbination of aerosolized heparin and a mucolytic ag ene, 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 childre n admitted between 1985 and 1989 acted as controls. forty-seven childr en admitted between 1990 and 1994 received 5000 units of heparin and 3 mi of a 20% solution of acetylcystine aerosolized every 4 hours the f irst: 7 days after the injury. All patients were extubated when they w ere able to maintain spontaneously a PaO2/FIO2 ratio of more than 400. The number of patients requiring reintubation for successive pulmonar y failure was recorded, as was mortality. The results indicate a signi ficant decrease in reintubation rates, in incidence of atelectasis, an d in mortality for patients treated with the regimen of heparin and ac etylcystine when compared with controls. Heparin/acetylcystine nebuliz ation in children with massive burn injury and smoke-inhalation injury results in a significant decrease in incidence of reintubation for pr ogressive pulmonary failure and a reduction in mortality.