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Aerosolized Salbutamol Accelerates the Resolution of Pulmonary Edema After Lung Resection^*

^* From the Departments of Anesthesiology (Drs. Licker and Ellenberger and Mr. Diaper), Thoracic Surgery (Dr. Robert), and Internal Medicine (Drs. Tschopp and Frey), University Hospital, Geneva, Switzerland.

Correspondence to: Professor Marc Licker, Département d’Anesthésiologie, Pharmacologie et Soins Intensifs, Hopital Universitaire, rue Micheli-Ducrest, CH-1211 Genève 14, Switzerland; e-mail: licker-marc-joseph{at}diogenes.hcuge.ch

Abstract

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.

Design: 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 (PaO₂/fraction of inspired oxygen [FIO₂] 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 PaO₂/FIO₂ 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 PaO₂/FIO₂ 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.

Trial registration: This protocol trial (CER03–160) has been registered at Clinicaltrials.gov under NCT00498251 [ClinicalTrials.gov] .

Key Words: acute lung injury • β-adrenergic receptor • salbutamol • thoracic surgery

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Aerosolized β-Adrenergic Agonist Therapy Reduces Pulmonary Edema Following Lung Surgery

Michael A. Matthay and Carolyn S. Calfee
Chest 2008 133: 833-835. [Full Text] [PDF]