Inhalation/intravenous recombinant tissue plasminogen activator and inhaled heparin in a patient with acute respiratory distress syndrome

Recent studies have demonstrated that lung fibrin deposits are associated w ith evolution of acute respiratory distress syndrome (ARDS). A young woman with ARDS resistant to conventional treatment was treated with ultrasonic n ebulized rt-PA (30 mg) and intravenous rt-PA (20 mg) over 2 h followed by c ontinuous treatment with ultrasonic nebulized unfractionated heparin (15 00 0 IU/day). The pulmonary gas exchange of the patient improved significantly and the condition of the patient stabilized during the hours following the fibrinolytic treatment. The potential use of nebulized thrombolytics for l ocal treatment of ARDS is discussed, and we conclude that combined nebulize d and intravenous therapy with thrombolytics may improve physiologic derang ements associated with acute lung injury in ARDS. (C) Harcourt Publishers L td 1999.