Nebulized Heparin for Prevention of Acute Lung Injury in Smoke Inhalation Injury

Inclusion Criteria: 1\. Adult patients indicated for elective intubation: * History of being trapped in a house or industrial fire. * Production of carbonaceous sputum. * Perioral facial burns affecting nose, lips, mouth, or throat . * Altered level of consciousness at any time after the incident and including confusion. * Symptoms of respiratory distress including a sense of suffocation, choking, breathlessness, and wheezing or discomfort affecting the eyes or throat, including irritation of the mucosal membranes. * Signs of respiratory distress including stertorous or labored breathing, and tachypnea or auscultatory abnormalities, including crepitations or rhonchi. * Hoarseness or loss of voice. 2. Evidence of bronchial burn by bronchoscopy to assess severity of inhalational trauma * NO injury: absence of carbonaceous deposits, erythema, oedema, brochorrhea, or obstruction. * Mild injury: minor patchy areas of erythema or carbonaceous deposits in proximal or distal bronchi. * Moderate injury: moderate degree of erythema, carbonaceous deposits, bronchorrhea, or bronchial obstructions. * Sever injury: sever inflammation with friability, copious carbonaceous deposits, bronchorrhea, or obstruction. * Massive injury: evidence of mucosal sloughing, necrosis or endoluminal obliteration. 3\. No evidence of acute lung injury at presentation (either by radiology or ABG) * Radiological findings: Normal lung without increased interstitial markings, ground glass opacification, or consolidation. * ABG findings : PaO2/ Fio2 \> 300. 4. Time between inhalational injury and intubation not longer than 24 hours. Exclusion Criteria: 1. Burn injury \> 24 hours. 2. History of pulmonary diseases. 3. Pregnancy or breast feeding. 4. History of allergy to heparin or HIT. 5. History or laboratory evidence of coagulopathy. 6. Burns area \> 50% of total body surface area. -