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Nebulized heparin and N-acetylcysteine for smoke inhalational injury: A case report.

Abstract Every year, ∼40,000 people suffer burn-related injuries in the United States. Despite recent advances, the odds of dying from exposure to fire, flames, or smoke are one in ∼1500. Smoke inhalation causes injury to the airways via a complex physiological process, and the treatment is mainly supportive. Many recent interventions aim to decrease the formation of fibrin casts, the main cause of airway damage in these patients. Among these, treatment with a combination of nebulized heparin and N-acetylcysteine (NAC) has shown benefit.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29742703
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Nebulized heparin and N-acetylcysteine for smoke inhalational injury: A case
      report.
PG  - e0638
LID - 10.1097/MD.0000000000010638 [doi]
AB  - RATIONALE: Every year, approximately 40,000 people suffer burn-related injuries
      in the United States. Despite recent advances, the odds of dying from exposure to
      fire, flames, or smoke are one in approximately 1500. Smoke inhalation causes
      injury to the airways via a complex physiological process, and the treatment is
      mainly supportive. Many recent interventions aim to decrease the formation of
      fibrin casts, the main cause of airway damage in these patients. Among these,
      treatment with a combination of nebulized heparin and N-acetylcysteine (NAC) has 
      shown benefit. PATIENT CONCERNS: We describe the case of a 58-year-old man who
      presented after smoke inhalation during a fire. Soot was found in the nostrils
      when he was admitted to our hospital, and after he began coughing up carbonaceous
      material, he was electively intubated and placed on volume assist control
      ventilation. DIAGNOSIS: Bronchoscopy on the first day of intensive care confirmed
      the injury from smoke inhalation and revealed mucosal edema and soot involving
      the tracheobronchial tree. INTERVENTIONS AND OUTCOMES: Inhaled unfractionated
      heparin of 10,000 IU in 3 mL of 0.9% normal saline alternating every 2 hours with
      3 mL of 20% NAC was started 48 hours after admission and continued for 7 days.
      Bronchoscopy on the fifth day of intensive care showed significant improvement in
      airway edema and a resolution of soot. LESSONS: On the basis of our experience
      with this case and limited literature, we posit that nebulized heparin and NAC
      may be of benefit in patients with inhalational smoke-induced lung injury and
      mild-to-severe lung injury scores.
FAU - Ashraf, Umair
AU  - Ashraf U
AD  - Division of Pulmonary and Critical Care Medicine, BronxCare Health System,
      Affiliated with Icahn School of Medicine at Mount Sinai.
FAU - Bajantri, Bharat
AU  - Bajantri B
AD  - Division of Pulmonary and Critical Care Medicine, BronxCare Health System,
      Affiliated with Icahn School of Medicine at Mount Sinai.
FAU - Roa-Gomez, Gabriella
AU  - Roa-Gomez G
AD  - Department of Internal Medicine.
FAU - Venkatram, Sindhaghatta
AU  - Venkatram S
AD  - Division of Pulmonary and Critical Care Medicine, BronxCare Health System,
      Affiliated with Icahn School of Medicine at Mount Sinai.
FAU - Cantin, Amanda
AU  - Cantin A
AD  - Department of Pharmacy, BronxCare Health System, Bronx, NY.
FAU - Diaz-Fuentes, Gilda
AU  - Diaz-Fuentes G
AD  - Division of Pulmonary and Critical Care Medicine, BronxCare Health System,
      Affiliated with Icahn School of Medicine at Mount Sinai.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anticoagulants)
RN  - 0 (Expectorants)
RN  - 9005-49-6 (Heparin)
RN  - WYQ7N0BPYC (Acetylcysteine)
SB  - AIM
SB  - IM
MH  - Acetylcysteine/*administration & dosage
MH  - Anticoagulants/*administration & dosage
MH  - Bronchial Diseases/drug therapy/etiology
MH  - Combined Modality Therapy
MH  - Edema/drug therapy/etiology
MH  - Expectorants/*administration & dosage
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nebulizers and Vaporizers
MH  - Smoke Inhalation Injury/complications/*drug therapy
MH  - Tracheal Diseases/drug therapy/etiology
EDAT- 2018/05/10 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1097/MD.0000000000010638 [doi]
AID - 00005792-201805110-00022 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0638. doi: 10.1097/MD.0000000000010638.