Streptokinase Versus Unfractionated Heparin Nebulization in Severe ARDS
Status:
Completed
Trial end date:
2018-01-30
Target enrollment:
Participant gender:
Summary
Background: Intra-alveolar clotting and alveolar collapse in ARDS is due to alveolar
capillaries epithelial and leakage. Subsequently, collapse induces hypoxemia that is
resistant to recruitment (RM). Heparin and Streptokinase may prevent or dissolve
intra-alveolar fibrin clot respectively helping alveolar re-expansion. We examined and
compared the effect of nebulizing Heparin versus Streptokinase on reversing this pathology.
Methods: Sixty severe ARDS (PaO2/FiO2<100) patients and failure of RM, prone position (PP)
and neuromuscular block (NMB) were partially randomised into Group (I): (n=20) received
nebulized Heparin 10000 IU/4h. Group (II): (n=20) received nebulized Streptokinase 250,000
IU/4h. Group (III): (n=20) received conservative management. Randomization to either Heparin
or Streptokinase groups was applied to patients whom guardian accepted participation, while
those who declined participation were followed-up as a control. The primary outcome was the
change in PaO2/FiO2; the secondary outcomes included the change in compliance, plateau
pressure, ventilation-off days, coagulation and ICU mortality.