Manocha Sanjay, Gordon Anthony C, Salehifar Ebrahim, Groshaus Horacio, Walley Keith R, Russell James A
Critical Care Research Laboratories, Centre for Cardiovascular and Pulmonary Research, University of British Columbia, Vancouver, BC, Canada.
Crit Care. 2006 Feb;10(1):R12. doi: 10.1186/cc3971.
Beta2 agonists have several properties that could be beneficial in acute lung injury (ALI). We therefore chose to study the effect of inhaled beta2 agonist use (salbutamol) on duration and severity of ALI.
We undertook a retrospective chart review of 86 consecutive mechanically ventilated patients with ALI, who had varying exposure to inhaled salbutamol. The cohort was divided into two groups according to the average daily dose of inhaled salbutamol they received ('high dose' > or = 2.2 mg/day and 'low dose' < 2.2 mg/day). Severity of ALI and non-pulmonary organ dysfunction was compared between the groups by calculating the days alive and free of ALI and other organ dysfunctions.
The high dose and low dose groups received a mean of 3.72 mg and 0.64 mg salbutamol per day, respectively. The high dose salbutamol group had significantly more days alive and free of ALI than the low dose group (12.2 +/- 4.4 days versus 7.6 +/- 1.9 days, p = 0.02). There were no associations between dose of beta agonist and non-pulmonary organ dysfunctions. High dose salbutamol (p = 0.04), APACHE II score (p = 0.02), and cause of ALI (p = 0.02) were independent variables associated with number of days alive and free of ALI in a multivariate linear regression model.
Our retrospective study suggests that salbutamol, an inhaled beta2 agonist, is associated with a shorter duration and lower severity of ALI. A dose greater than 2.2 mg/day of inhaled salbutamol could be a minimal effective dose to evaluate in a randomized controlled trial.
β2激动剂具有多种特性，可能对急性肺损伤（ALI）有益。因此，我们选择研究吸入β2激动剂（沙丁胺醇）对ALI病程和严重程度的影响。
我们对86例连续接受机械通气的ALI患者进行了回顾性病历审查，这些患者吸入沙丁胺醇的暴露情况各不相同。根据患者接受的吸入沙丁胺醇平均日剂量，将该队列分为两组（“高剂量”≥2.2毫克/天和“低剂量”<2.2毫克/天）。通过计算存活且无ALI及其他器官功能障碍的天数，比较两组间ALI的严重程度和非肺部器官功能障碍情况。
高剂量组和低剂量组每天分别平均接受3.72毫克和0.64毫克沙丁胺醇。高剂量沙丁胺醇组存活且无ALI的天数显著多于低剂量组（12.2±4.4天对7.6±1.9天，p = 0.02）。β激动剂剂量与非肺部器官功能障碍之间无关联。在多变量线性回归模型中，高剂量沙丁胺醇（p = 0.04）、急性生理与慢性健康状况评分系统II（APACHE II）评分（p = 0.02）以及ALI病因（p = 0.02）是与存活且无ALI天数相关的独立变量。
我们的回顾性研究表明，吸入性β2激动剂沙丁胺醇与ALI病程缩短和严重程度降低相关。吸入沙丁胺醇剂量大于2.2毫克/天可能是在随机对照试验中评估的最小有效剂量。
