[EngO4] English Session4

[EngO4-6] Nebulized adrenaline attenuates lung alveolar and interstitial edema compared to phenylephrine and salbutamol in ovine burn and smoke inhalation injury model

Satoshi Fukuda^1,2, Koji Ihara^1,3, Yosuke Niimi^1,3, Ernesto Lopez¹, Keibun Liu¹, Clark R. Andersen^1,4, Robert A. Cox^2,5, David N. Herndon^1,2, Donald S. Prough^1,2, Perenlei Enkhbaatar^1,2 (1.Department of Anesthesiology, University of Texas Medical Branch at Galveston, USA, 2.Shriners Hospital for Children, USA, 3.Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan, 4.Department of Preventive Medicine & Community Health, Office of Biostatistics, University of Texas Medical Branch, Galveston, USA, 5.Department of Pathology, University of Texas Medical Branch, Galveston, USA)

BACKGROUND: Smoke inhalation-induced acute lung injury (ALI) increases the mortality of burn patients up to 60%. The severity of ALI is associated with lung alveolar/interstitial edema and airway mucosal hyperemia. This study was aimed to test the hypothesis that nebulized adrenaline (non-specific adrenergic receptor agonist) more effectively ameliorates the severity of burn and smoke inhalation-induced ALI than nebulized phenylephrine (α-1), and Salbutamol (β-2).
METHODS: The injury was induced in 46 female sheep by 40% TBSA, 3rd° burn and 48 breaths of cotton smoke inhalation under anesthesia and analgesia. Post-injury, sheep were mechanically ventilated and monitored their cardiopulmonary hemodynamics and lung lymph flow for 48 hours in a conscious state. Lung edema was assessed by measuring pulmonary vascular permeability index (PVPI), lung and trachea wet-to-dry weight ratio (W/D). Sheep were randomly allocated to 4 groups; 1) Adrenaline, 4 mg, n=11; 2) Phenylephrine, 10 mg, n=6; 3) Salbutamol, 6.6 mg, n=12; and 4) Control (saline), n=17. The nebulization began 1 hr post-injury and repeated every 4 hours thereafter.
RESULTS: The Adrenaline significantly improved PaO₂/FiO₂ ratio and oxygenation index, and significantly reduced PVPI compared to control and Salbutamol. Lung and trachea W/D was significantly less in Adrenaline compared to both control and Salbutamol and control, respectively. In histopathological assessment, Adrenaline significantly reduced alveolar edema score compared to control (see table). No adverse effects were observed in all drug groups.
CONCLUSIONS: The adrenaline nebulization attenuated both lung alveolar/interstitial and airway edema, and improved pulmonary mechanics. The nebulization of adrenaline may be considered as an early care of burn patients with smoke inhalation-induced ALI.