Streptokinase Versus Unfractionated Heparin Nebulization in Patients With Severe Acute Respiratory Distress Syndrome...

To examine and compare nebulizing heparin versus streptokinase for reversing alveolar collapse nonresponsive to recruitment.

A clinical trial at a tertiary intensive care unit (ICU). Sixty patients with severe acute respiratory distress syndrome (ARDS) (PaO₂/F_IO₂ <100) nonresponsive to recruitment maneuver (RM), prone position, and neuromuscular block (NMB) were randomized into intervention arms or the standard-of-care arm.

The ICU at Beni-Suef University Hospital.

Sixty patients with severe ARDS (PaO₂/F_IO₂ <100) nonresponsive to RM, PP, and NMB.

Nebulized heparin (10,000 IU/4 h), nebulized streptokinase (250,000 IU/4 h), and conservative management.

The primary outcome was the change in PaO₂/F_IO₂; the secondary outcomes included the change in compliance, plateau pressure, coagulation, and ICU mortality. The PaO₂/F_IO₂ was significantly higher in the streptokinase group from day 1 to day 8 compared to the heparin and standard-of-care groups. Streptokinase produced PaO₂/F_IO₂>100 at day 1, >200 at day 5, and >300 at day 7. The heparin group achieved a PaO₂/F_IO₂ >100 at day 5 but remained <200 until day 8. The standard-of-care group did not achieve a PaO₂/F_IO₂>100 after 8 days. Streptokinase significantly reduced plateau pressure and improved compliance at day 8. Only streptokinase decreased PaCO₂ (p < 0.0001). Moreover, ICU mortality was significantly lower in streptokinase patients compared to other groups. Additionally, no heparin-induced thrombocytopenia was observed in all groups.

Inhaled streptokinase serves as rescue therapy in patients with severe ARDS with improving oxygenation and lung mechanics more quickly than heparin or conventional management.