Early treatment with nebulised salbutamol worsens physiological measures and does not improve survival following phosgene induced acute lung injury.
OBJECTIVE
To examine the effectiveness of nebulised salbutamol in the treatment of phosgene induced acute lung injury.


METHODS
Using previously validated methods, 12 anaesthetised large white pigs were exposed to phosgene (Ct 1978 +/- 8 mg min m(-3)), established on mechanical ventilation and randomised to treatment with either nebulised salbutamol (2.5 mg per dose) or saline control. Treatments were given 1, 5, 9, 13, 17 and 21 hours following phosgene exposure. The animals were followed to 24 hours following phosgene exposure.


RESULTS
Salbutamol treatment had no effect on mortality and had a deleterious effect on arterial oxygenation, shunt fraction and heart rate. There was a reduction in the number of neutrophils from 24.0% +/- 4.4 to 12.17% +/- 2.1 (p < 0.05) in bronchoalveolar lavage, with some small decreases in inflammatory mediators in bronchoalveolar lavage but not in plasma.


CONCLUSIONS
Nebulised salbutamol treatment following phosgene induced acute lung injury does not improve survival, and worsens various physiological parameters including arterial oxygen partial pressure and shunt fraction. Salbutamol treatment reduces neutrophil influx into the lung. Its sole use following phosgene exposure is not recommended.
Grainge
C
C
Institute of Naval Medicine, Alverstoke, Hampshire.
Brown
R
R
Jugg
B J
BJ
Smith
A J
AJ
Mann
T M
TM
Jenner
J
J
Rice
P
P
Parkhouse
D A
DA
D055371:Acute Lung Injury / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D018893:Bronchoalveolar Lavage; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D009330:Nebulizers and Vaporizers; D009504:Neutrophils / Q000187:drug effects; D010705:Phosgene / Q000009:adverse effects*; D013552:Swine; D013997:Time Factors
D001993:Bronchodilator Agents; D002619:Chemical Warfare Agents; D010705:Phosgene; D000420:Albuterol