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

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 pneumonia/AERDS.