Aerosolized salbutamol accelerates the resolution of pulmonary edema after lung resection.
BACKGROUND
Ischemia-reperfusion injuries, fluid overload, and cardiac insufficiency may all contribute to alveolar and interstitial lung edema. We hypothesized that aerosolized salbutamol would reduce extravascular lung water and improve oxygenation after lung resection by stimulating epithelial fluid clearance and cardiovascular function.


METHODS
Blinded, randomized, cross-over trial.


METHODS
We selected 24 patients with risk factors for lung edema. Aerosolized drugs (salbutamol, 5 mg; vs ipratropium, 0.5 mg) were administered on two consecutive trials, with a 6-h washout period, on the day of surgery (postoperative day [POD]-0) as well as on POD-1. Before and 50 min after the end of drug administration, we determined the oxygenation index (Pao(2)/fraction of inspired oxygen [Fio(2)] ratio), the extravascular lung water index (EVLWI), the pulmonary vascular permeability index (PVPI), and the cardiac index (CI) using the single-indicator thermal dilution technique.


RESULTS
Complete data were obtained in 21 patients. On POD-0, the EVLWI was increased compared with preoperative values (13.0 +/- 3.8 vs 9.1 +/- 4.4, p < 0.001); salbutamol treatment induced significant increases in Pao(2)/Fio(2) ratio (+ 25 +/- 13%) that were associated with decreases in EVLWI (- 18 +/- 10%, p < 0.05) and in PVPI (- 19 +/- 10%, p < 0.05) along with increased CI (+ 23 +/- 11%, p < 0.05). On POD-1, repeated nebulization of salbutamol induced significant increases in Pao(2)/Fio(2) ratio and CI (+ 22 +/- 10% and 19 +/- 11%, respectively), whereas both EVLWI and PVPI remained unchanged. Nebulization of ipratropium bromide did not produce significant hemodynamic and respiratory changes on POD-0 and POD-1.


CONCLUSIONS
Aerosolized salbutamol accelerates the resolution of lung edema, improves blood oxygenation, and stimulated cardiovascular function after lung resection in high-risk patients.


BACKGROUND
This protocol trial (CER03-160) has been registered at (Clinicaltrials.gov) under NCT00498251.
Licker
Marc
M
Département d'Anesthésiologie, Pharmacologie et Soins Intensifs, Hopital Universitaire, rue Micheli-Ducrest, Genève 14, Switzerland. licker-marc-joseph@diogenes.hcuge.ch
Tschopp
Jean-Marie
JM
Robert
John
J
Frey
Jean-Georges
JG
Diaper
John
J
Ellenberger
Christoph
C
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D018678:Cholinergic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use; D008168:Lung / Q000187:drug effects / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011013:Pneumonectomy / Q000009:adverse effects*; D011654:Pulmonary Edema / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control
D000318:Adrenergic beta-Agonists; D018678:Cholinergic Agents; D009241:Ipratropium; D000420:Albuterol; D010100:Oxygen