Nebulized Heparin for Prevention of Acute Lung Injury in Smoke Inhalation Injury

Inclusion Criteria

• •1\. Adult patients indicated for elective intubation:
• •History of being trapped in a house or industrial fire.
• •Production of carbonaceous sputum.
• •Perioral facial burns affecting nose, lips, mouth, or throat .
• •Altered level of consciousness at any time after the incident and including confusion.
• •Symptoms of respiratory distress including a sense of suffocation, choking, breathlessness, and wheezing or discomfort affecting the eyes or throat, including irritation of the mucosal membranes.
• •Signs of respiratory distress including stertorous or labored breathing, and tachypnea or auscultatory abnormalities, including crepitations or rhonchi.
• •Hoarseness or loss of voice. 2. Evidence of bronchial burn by bronchoscopy to assess severity of inhalational trauma
• •NO injury: absence of carbonaceous deposits, erythema, oedema, brochorrhea, or obstruction.
• •Mild injury: minor patchy areas of erythema or carbonaceous deposits in proximal or distal bronchi.
• •Moderate injury: moderate degree of erythema, carbonaceous deposits, bronchorrhea, or bronchial obstructions.
• •Sever injury: sever inflammation with friability, copious carbonaceous deposits, bronchorrhea, or obstruction.
• •Massive injury: evidence of mucosal sloughing, necrosis or endoluminal obliteration.
• •3\. No evidence of acute lung injury at presentation (either by radiology or ABG)
• •Radiological findings: Normal lung without increased interstitial markings, ground glass opacification, or consolidation.
• •ABG findings : PaO2/ Fio2 \> 300. 4. Time between inhalational injury and intubation not longer than 24 hours.