Emerging treatments

Nebulized heparin

Heparin may help prevent fibrin deposition in the airways and alveoli of acute respiratory distress syndrome (ARDS) patients.[39] Preliminary clinical and animal data show promise, but a multicenter trial is lacking.[49][50]

Tocopherols

Tocopherols scavenge reactive oxygen and nitrogen species, and have shown efficacy in animal models.[40] 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][51] No data have supported a role for systemic corticosteroids in reducing inflammation in inhalation injury.[52]

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]

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]

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]

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