Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation.
OBJECTIVE
Albuterol, due to its bronchodilatory and anti-inflammatory effects, is given via continuous nebulization in children with severe asthma. Combined burn and smoke inhalation injury frequently results in acute lung injury due to a combination of airway obstruction and inflammation. We hypothesized that albuterol administered via continuous nebulization would mitigate acute lung injury after smoke inhalation injury and burn.


METHODS
Randomized prospective animal model.


METHODS
Twenty adult female sheep (mean weight, 33.1+/-0.9 kg).


METHODS
Adult ewes were subjected to a 40% body surface area third-degree flame burn and smoke inhalation injury after tracheostomy. Sheep were allocated to a) sham group, b) saline continuous nebulization group, c) 20 mg of albuterol continuous nebulization group, or d) 40 mg of albuterol continuous nebulization group (n=5 animals per group). All groups received intravenous lactated Ringer's solution at 4 mL.kg-1.%burn(-1).24 hrs-1 for resuscitation and were equally mechanically ventilated throughout the 48-hr study period. Pulmonary and cardiac function, lung lymph flow, bronchial obstruction score, and wet/dry lung weights were recorded.


RESULTS
Compared with saline and control groups, the albuterol groups had lower pause and peak inspiratory pressures, decreased pulmonary transvascular fluid flux, a significantly higher Pao2/Fio2 ratio, and decreased shunt fraction at 48 hrs postinjury. The wet-to-dry lung weight ratio and bronchial obstruction scores were lower for sheep receiving albuterol.


CONCLUSIONS
Continuous nebulization of albuterol improves pulmonary function via improved airway clearance and decreased fluid flux in a combined burn/smoke inhalation injury model.
Palmieri
Tina L
TL
Shriners Hospitals for Children Northern California and University of California-Davis, Sacramento, CA, USA.
Enkhbaatar
Perenlei
P
Bayliss
Robert
R
Traber
Lillian D
LD
Cox
Robert A
RA
Hawkins
Hal K
HK
Herndon
David N
DN
Greenhalgh
David G
DG
Traber
Daniel L
DL
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage* / Q000627:therapeutic use; D000818:Animals; D016084:Bronchoconstriction / Q000187:drug effects; D004195:Disease Models, Animal; D005260:Female; D007320:Inspiratory Capacity / Q000187:drug effects; D009330:Nebulizers and Vaporizers; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011897:Random Allocation; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012756:Sheep; D015208:Smoke Inhalation Injury / Q000150:complications*; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D000420:Albuterol