In patients with or at risk of acute respiratory distress syndrome (ARDS), nebulised heparin did not improve self-reported performance of daily physical activities, but was well tolerated and exploratory outcomes suggest less progression of lung injury and earlier return home.

Further research is justified to establish if nebulised heparin accelerates recovery in those who have or are at risk of ARDS.

Between Sept 4, 2012, and Aug 23, 2018, 256 patients were randomised.

The Can Heparin Administration Reduce Lung Injury (CHARLI) study was an investigator-initiated, multicentre, double-blind, randomised phase 3 trial across nine hospitals in Australia.

Adult intensive care patients on invasive ventilation, with impaired oxygenation defined by a PaO2/FiO2 ratio of less than 300, and with the expectation of invasive ventilation beyond the next calendar day were recruited.

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