Interventions
Participants assigned to “nebulised UFH” receive nebulised UFH in
addition to the standard care required as determined by the treating
team. The dose, frequency, duration and delivery method differ between
participating studies as follows:
- Brazil, USA, UK and Australia: 25,000 IU UFH every 6 hours using a
vibrating mesh nebuliser (Aerogen Solo), for a maximum of 21 days or
until the modified ordinal scale is 1 or 2 (Table 1)
- Egypt: 1000 IU/kg predicted body weight UFH every 6 hours for 7 days
using a compressed air nebuliser (Beurer IH18)
- Argentina: 5000 IU UFH every 8 hours for 7 days using a Venturi system
connected to a full-face mask (Free Breath) fitted with an HMF
anti-viral expiratory filter
Participants assigned to ‘standard care’ will receive the standard care
required as determined by the treating team and will not be
treated with nebulised heparin.
Nebulised UFH will be stopped if the patient has been intubated and
commenced on invasive mechanical ventilation.
Nebulised UFH will be withheld if any of the following occurs:
- The treating physician deems that there is a clinically unacceptable
increase in APTT
- The treating physician deems that there is excessive bloodstaining of
respiratory secretions
- There is pulmonary bleeding, major bleeding or suspected or confirmed
heparin-induced thrombocytopaenia (HIT)
Nebulised UFH will be recommenced if:
- Having been withheld because the APTT was unacceptably prolonged, the
APTT becomes acceptable
- Having been withheld because there was excessive bloodstaining of
upper or lower respiratory secretions, the bloodstaining of the
respiratory secretions has resolved
- Having been withheld for pulmonary bleeding or major bleeding, the
bleeding is definitively controlled
- Having been withheld for suspected HIT, the patient is found not to
have this condition