Trial reportIntensive care medicine2008
Elevated pulmonary dead space and coagulation abnormalities suggest lung microvascular thrombosis in patients undergoing cardiac surgery.
Trial report in Intensive care medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Primary prophylaxis for venous thromboembolism in patients undergoing cardiac or thoracic surgery.The Cochrane database of systematic reviews · 2015Pooled it
- Nebulised heparin for patients with or at risk of acute respiratory distress syndrome: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial.The Lancet. Respiratory medicine · 2021Trial
- Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial.Critical care (London, England) · 2010Trial
- Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS.Journal of critical care · 2022Article
- Can nebulised HepArin Reduce morTality and time to Extubation in patients with COVID-19 Requiring invasive ventilation Meta-Trial (CHARTER-MT): Protocol and statistical analysis plan for an investigator-initiated international meta-trial of prospective randomised clinical studies.British journal of clinical pharmacology · 2022Article
- Effect of Nebulized Heparin on Weaning off Intubated Patients with Acute Respiratory Distress Syndrome (ARDS) Admitted to Intensive Care Unit (ICU): A Randomized Clinical Trial.Anesthesiology and pain medicine · 2021Article
- Nebulised heparin as a treatment for COVID-19: scientific rationale and a call for randomised evidence.Critical care (London, England) · 2020Review
- Can Transcutaneous CO2 Tension Be Used to Calculate Ventilatory Dead Space? A Pilot Study.Critical care research and practice · 2016Article
- Quantifying the severity of acute lung injury using dead-space ventilation: should the lung injury score be updated?Respiratory care · 2012Article
- Ratio of angiopoietin-2 to angiopoietin-1 as a predictor of mortality in acute lung injury patients.Critical care medicine · 2010Article
- Higher pulmonary dead space may predict prolonged mechanical ventilation after cardiac surgery.Pediatric pulmonology · 2009Article
- Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation.Intensive care medicine · 2009Review
- Aprotinin and microvascular thrombosis in cardiac surgery.Intensive care medicine · 2008Article
- A phase 1 trial of nebulised heparin in acute lung injury.Critical care (London, England) · 2008Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveInflammation has been shown to trigger microvascular thrombosis. Patients undergoing cardiac surgery sustain significant inflammatory insults to the lungs and in addition are routinely given anti-fibrinolytic agents to promote thrombosis. In view of these risk factors we investigated if evidence of pulmonary microvascular thrombosis occurs following cardiac surgery and, if so, whether a pre-operative heparin infusion may limit this.
designDouble-blind randomised controlled trial.
settingTertiary university affiliated hospital. PATIENTS: Twenty patients undergoing elective cardiac surgery.
interventionsPatients were randomised to receive a pre-operative heparin infusion or placebo. All patients were administered aprotinin. MEASUREMENTS AND
resultsPulmonary microvascular obstruction was estimated by measuring the alveolar dead-space fraction. Pulmonary coagulation activation was estimated by measuring the ratio of prothrombin fragment levels in radial and pulmonary arterial blood. Systemic tissue plasminogen activator (t-PA) levels were also assessed. In the placebo group cardiac surgery triggered increased alveolar dead-space fraction levels and the onset of prothrombin fragment production in the pulmonary circulation. Administration of pre-operative heparin was associated with a lower alveolar dead-space fraction (p < 0.05) and reduced prothrombin fragment production in the pulmonary circulation (p < 0.05). Pre-operative heparin also increased baseline t-PA levels (p < 0.05).
conclusionThe changes in the alveolar dead-space fraction and pulmonary coagulation activation suggest that pulmonary microvascular thrombosis develops during cardiac surgery and this may be limited by a pre-operative heparin infusion.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.