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Aerosolized salbutamol accelerates the resolution of pulmonary edema after lung resection

Marc Licker, MD^*; Jean-Marie Tschopp, MD^#; John Robert, MD; Jean-Georges Frey, MD^#; John Diaper, RN^* and Christoph Ellenberger, MD^*

^*Department of Anesthesiology, University Hospital, CH-1211 Geneva, Switzerland Thoracic Surgery, University Hospital, CH-1211 Geneva, Switzerland ^#Internal Medicine, University Hospital, CH-1211 Geneva, Switzerland

Abstract

BackgroundIschemia-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.

DesignBlinded, randomized, cross-over trial.

MethodsWe selected 24 patients with risk factors for lung edema. Aerosolized drugs (salbutamol 5 mg vs. ipratropium 0.5 mg) were given on 2 consecutive trials, with a 6-hours washout period, on the day of surgery (POD 0) as well as on the first postoperative day (POD1). Before and 50 min after the end of drug administration, we determined the oxygenation index (PaO₂/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.

ResultsComplete data were obtained in 21 patients. On POD0, 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 was associated with decreases in EVLWI (-18±10%, P<0.05) and in PVPI (-19±10%, P<0.05) along with increased cardiac index (+23±11 %, P<0.05).

On POD1, 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 POD0 and POD1.

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

Key Words: Acute lung injury • thoracic surgery • beta-adrenergic receptor • salbutamol

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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]