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Thursday 08 November 2007

Aerosolized salbutamol accelerates the resolution of pulmonary edema after lung resection.

By: Licker M, Tschopp JM, Robert J, Frey JG, Diaper J, Ellenberger C.

Chest 2007 Nov;(): [Epub ahead of print]

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 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 (PaO(2)/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 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 PaO(2)/FIO(2) 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 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 POD0 and POD1. Conclusions Aerosolized salbutamol accelerates the resolution of lung edema, improves blood oxygenation and stimulated cardiovascular function after lung resection in high-risk patients.

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