Aerosolized beta(2)-adrenergic agonists achieve therapeutic levels in the pulmonary edema fluid of ventilated patients with acute respiratory failure.
OBJECTIVE
Experimental studies demonstrate that beta-adrenergic agonists markedly stimulate alveolar fluid clearance if concentrations of 10(-6) M are achieved in alveolar fluid. However, no studies have determined whether aerosolized beta-adrenergic agonists are delivered to the distal air spaces of the lung in therapeutic concentrations in patients with pulmonary edema.


METHODS
This retrospective study measured albuterol levels in the pulmonary edema fluid and plasma from mechanically ventilated patients with pulmonary edema from a hydrostatic mechanism ( n=10) or from acute lung injury ( n=12).


RESULTS
After a total aerosolized albuterol dose of 4.2+/-3.2 mg in the prior 6 h the median pulmonary edema fluid albuterol level was 1,250 ng/ml (10(-6) M) in patients with hydrostatic pulmonary edema; after 3.5+/-2.6 mg the figure was 1,240 ng/ml (10(-6) M) in patients with pulmonary edema from acute lung injury. Plasma albuterol levels were much lower, with a median of 5.2 ng/ml (0.01 x 10(-6) M) in patients with hydrostatic pulmonary edema and 3.1 ng/ml (0.01 x 10(-6) M) in patients with pulmonary edema from acute lung injury.


CONCLUSIONS
These results provide the first evidence that levels of beta-adrenergic agonists that are physiologically efficacious in experimental models can be achieved with conventional delivery systems in ventilated, critically ill patients with acute respiratory failure from pulmonary edema.
Atabai
Kamran
K
Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0130, USA.
Ware
Lorraine B
LB
Snider
Mary E
ME
Koch
Patrick
P
Daniel
Brian
B
Nuckton
Thomas J
TJ
Matthay
Michael A
MA
D018806:APACHE; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D000336:Aerosols; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D015633:Extravascular Lung Water / Q000737:chemistry*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000473:pathology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000145:classification / Q000188:drug therapy*; D012189:Retrospective Studies
D000318:Adrenergic beta-Agonists; D000336:Aerosols; D000420:Albuterol