Role of Heparin Nebulization in Acute Respiratory Distress Syndrome after Neurotoxic Snakebite

Emergency intubation was done with an endotracheal tube 7.5 mm and put on mechanical ventilation in AC-VC mode, FiO 2 : 60%, TV: 320 mL, and positive end-expiratory pressure (PEEP): 6 cm H 2 O.The patient was shifted to the intensive care unit (ICU) for further management.After a few hours of treatment, neurological examination showed improvement with GCS of E2VTM5 with no plantar reflex, while bilateral pupils were normal and sluggishly reactive to light.On chest auscultation, bilateral air entry with diffuse crepitations was present.Arterial blood gas (ABG) analysis showed respiratory acidosis, and chest X-ray showed diffuse lung opacity (Fig. 1).Baseline measurements were hemoglobin 15.1 gm/dL, total leukocyte count 10.61/mm 3 , prothrombin time 18.6 seconds, international normalized ratio (INR) 1.5, and activated partial thromboplastin time 27.4 seconds.Her serum urea and creatinine were 29.3 and 0.43 mg/dL, respectively.