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Could nebulized heparin be the magic treatment for COVID-19 Pneumonia and ARDS?

Journal of Anesthesia & Critical Care: Open Access
Khaled Sewify,1 Ahmed R Shoala,2 Abdelaziz Alshaer,3 Ashraf Amin,4 Rehab Y AL-Ansari5

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Background: The global spread of the novel strain of coronavirus referred to as severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the continuous
rise in the hospitalization of people suffering from COVID-19 in various parts of the world.
The predominant symptoms experienced by patients diagnosed with SARS-CoV-2 infection
include pneumonia and acute respiratory distress syndrome (ARDS). These symptoms
have contributed to the high mortality rate of COVID-19 patients across the globe. Recent
studies have indicated that nebulized unfractionated heparin (UFH) can be employed in the
treatment of pneumonia and acute respiratory distress syndrome (ARDS) in hospitalized
patients who have been diagnosed with SARS-CoV-2 infection.
Case description: The case study for this investigation was a 37-year-old Saudi woman
who had muscular dystrophy, bronchial asthma, and diabetes mellitus. This hospitalized
patient who was a wheelchair bound was admitted to the intensive care unit (ICU) due to
the onset of severe COVID-19 related pneumonia and ARDS. The patient was intubated
and placed on high mechanical ventilation support with protective lung strategy (low
tidal volume and high PEEP level), prone positioning, administering inhaled nitric oxide
therapy, and the intravenous infusion methylprednisolone together with antiviral agents
and empiric antibiotics for seven days. Despite the administration of this maximal therapy,
she continued to have refractory hypoxemia and severe ARDS. As a result, a high dose
of UFH was administered to the patient through nebulization. After administering nine
different doses of nebulized UFH, the patient’s oxygenation and inflammatory markers
have remarkably improved, then she had a very smooth course and successfully weaned
off mechanical ventilation.
Conclusion: This treatment strategy resulted in a significant improvement in the P/F
ratio, a remarkable reduction in the bilateral lung infiltrates and inflammatory markers and
eventually weaning of mechanical ventilation in the COVID-19 patient. This case suggests
that nebulized UFH has a strong scientific and biological basis to test its use as a therapy
for COVID-19 pneumonia and ARDS as it may offer huge clinical benefit across the time
course of the disease as well may prevent progression of infection If administered early at
the onset of symptoms, and may finally prevent the needs for mechanical ventilation.
Learning points: Randomized controlled trials should be carried out to investigate the
clinical impacts of nebulized UFH in both prevention and treatment of COVID-19


COVID-19, SARS-CoV-2, pneumonia, unfractionated heparin, nebulization, ARDS