Nebulized heparin
Heparin may help prevent fibrin deposition in the airways and alveoli of acute respiratory distress syndrome (ARDS) patients.[39]Enkhbaatar P, Herndon DN, Traber DL. Use of nebulized heparin in the treatment of smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):159-62.
http://www.ncbi.nlm.nih.gov/pubmed/19180699?tool=bestpractice.com
Preliminary clinical and animal data show promise, but a multicenter trial is lacking.[49]Miller AC, Elamin EM, Suffredini AF. Inhaled anticoagulation regimens for the treatment of smoke inhalation-associated acute lung injury: a systematic review. Crit Care Med. 2014 Feb;42(2):413-9.
http://www.ncbi.nlm.nih.gov/pubmed/24158173?tool=bestpractice.com
[50]Elsharnouby NM, Eid HE, Abou Elezz NF, et al. Heparin/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses. J Crit Care. 2014 Feb;29(1):182.e1-4.
http://www.ncbi.nlm.nih.gov/pubmed/23932140?tool=bestpractice.com
Tocopherols
Tocopherols scavenge reactive oxygen and nitrogen species, and have shown efficacy in animal models.[40]Traber DL, Traber MG, Enkhbaatar P, et al. Tocopherol as treatment for lung injury associated with burn and smoke inhalation. J Burn Care Res. 2009 Jan-Feb;30(1):164-5.
http://www.ncbi.nlm.nih.gov/pubmed/19060745?tool=bestpractice.com
Tocopherols, with the exception of alpha-tocopherols, are not currently approved for use in humans.
Corticosteroids
Several small studies in ARDS have demonstrated the potential benefit of inhaled corticosteroids, but their use in inhalation injury is unclear.[41]Greenhalgh DG. Steroids in the treatment of smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):165-9.
http://www.ncbi.nlm.nih.gov/pubmed/19060744?tool=bestpractice.com
[51]de Lange DW, Meulenbelt J. Do corticosteroids have a role in preventing or reducing acute toxic lung injury caused by inhalation of chemical agents? Clin Toxicol (Phila). 2011 Feb;49(2):61-71.
http://www.ncbi.nlm.nih.gov/pubmed/21370942?tool=bestpractice.com
No data have supported a role for systemic corticosteroids in reducing inflammation in inhalation injury.[52]Bartley AC, Edgar DW, Wood FM. Pharmaco-management of inhalation injuries for burn survivors. Drug Des Devel Ther. 2009 Feb 6;2:9-16.
http://www.ncbi.nlm.nih.gov/pubmed/19920889?tool=bestpractice.com
Vitamin C
High-dose vitamin C has demonstrated improvement in oxygenation in small trials, although the mechanism is unknown and large trials are lacking.[43]Wolf SE. Vitamin C and smoke inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):184-6.
http://www.ncbi.nlm.nih.gov/pubmed/19060764?tool=bestpractice.com
Antithrombin-III
Patients with burn injuries have been noted to develop deficiency of antithrombin, a serine protease inhibitor with anti-inflammatory properties. Repletion of antithrombin-III is under clinical investigation; however, it has not been proven effective in large clinical trials.[44]Latenser, BA. Use of antithrombin III in inhalation injury. J Burn Care Res. 2009 Jan-Feb;30(1):186-8.
http://www.ncbi.nlm.nih.gov/pubmed/19060754?tool=bestpractice.com
Anti-inflammatory agents
Inhibition of the cyclooxygenase (COX) and lipoxygenase inflammatory pathways with agents such as nonsteroidal anti-inflammatory medications and leukotriene inhibitors have demonstrated promise in animal models, but human trials are lacking.[52]Bartley AC, Edgar DW, Wood FM. Pharmaco-management of inhalation injuries for burn survivors. Drug Des Devel Ther. 2009 Feb 6;2:9-16.
http://www.ncbi.nlm.nih.gov/pubmed/19920889?tool=bestpractice.com