To systematically evaluate the efficacy and safety of nebulized heparin in patients with inhalation injury.

A systematic search was conducted in PubMed，Embase，the Cochrane Library，the China National Knowledge Infrastructure （CNKI），and the Wanfang Data Knowledge Service Platform for literatures about the use of nebulized heparin in patients with inhalation injury published from database inception to September 1，2025. Two reviewers independently conducted literature screening，data extraction，and risk of bias assessment. Meta-analysis was performed using RevMan 5.4 software.

A total of 11 studies involving 710 patients with inhalation injury were included. Meta-analysis results showed that，compared with conventional treatment，nebulized heparin reduced 28-day mortality （RR=0.74，95%CI：0.59 to 0.92，P=0.008），shortened the duration of mechanical ventilation （MD=-3.86，95%CI： -5.71 to -2.01，P<0.001）. The pooled result of only 2 studies （238 patients） showed that nebulized heparin could improve the oxygenation index （MD=18.07，95%CI： 12.51 to 23.64，P<0.001）. In terms of safety，there was no statistically significant difference in the incidence of pneumonia between patients receiving nebulized heparin therapy and those receiving conventional treatment （RR=0.95，95%CI： 0.68 to 1.32，P=0.76）. The pooled result of only 3 studies （223 patients） showed no statistically significant difference in the incidence of bleeding events between patients treated with the two methods （RR=1.02，95%CI： 0.82 to 1.27，P=0.87）.

Early initiation of a combination regimen centered on nebulized heparin in patients with inhalation injury may help reduce 28-day mortality and shorten the duration of mechanical ventilation, without increasing the risk of pneumonia，indicating a favorable safety profile.