Palmieri Tina L, Enkhbaatar Perenlei, Bayliss Robert, Traber Lillian D, Cox Robert A, Hawkins Hal K, Herndon David N, Greenhalgh David G, Traber Daniel L
Shriners Hospitals for Children Northern California and University of California-Davis, Sacramento, CA, USA.
Crit Care Med. 2006 Jun;34(6):1719-24. doi: 10.1097/01.CCM.0000217215.82821.C5.
Albuterol, due to its bronchodilatory and anti-inflammatory effects, is given via continuous nebulization in children with severe asthma. Combined burn and smoke inhalation injury frequently results in acute lung injury due to a combination of airway obstruction and inflammation. We hypothesized that albuterol administered via continuous nebulization would mitigate acute lung injury after smoke inhalation injury and burn.
Randomized prospective animal model.
Twenty adult female sheep (mean weight, 33.1+/-0.9 kg).
Adult ewes were subjected to a 40% body surface area third-degree flame burn and smoke inhalation injury after tracheostomy. Sheep were allocated to a) sham group, b) saline continuous nebulization group, c) 20 mg of albuterol continuous nebulization group, or d) 40 mg of albuterol continuous nebulization group (n=5 animals per group). All groups received intravenous lactated Ringer's solution at 4 mL.kg-1.%burn(-1).24 hrs-1 for resuscitation and were equally mechanically ventilated throughout the 48-hr study period. Pulmonary and cardiac function, lung lymph flow, bronchial obstruction score, and wet/dry lung weights were recorded.
Compared with saline and control groups, the albuterol groups had lower pause and peak inspiratory pressures, decreased pulmonary transvascular fluid flux, a significantly higher Pao2/Fio2 ratio, and decreased shunt fraction at 48 hrs postinjury. The wet-to-dry lung weight ratio and bronchial obstruction scores were lower for sheep receiving albuterol.
Continuous nebulization of albuterol improves pulmonary function via improved airway clearance and decreased fluid flux in a combined burn/smoke inhalation injury model.
由于沙丁胺醇具有支气管扩张和抗炎作用，常用于重度哮喘患儿的持续雾化治疗。烧伤合并烟雾吸入伤常因气道阻塞和炎症导致急性肺损伤。我们推测，持续雾化吸入沙丁胺醇可减轻烟雾吸入伤和烧伤后的急性肺损伤。
随机前瞻性动物模型。
20只成年雌性绵羊（平均体重33.1±0.9千克）。
成年母羊在气管切开术后遭受40%体表面积的三度火焰烧伤和烟雾吸入伤。绵羊被分为：a）假手术组；b）生理盐水持续雾化组；c）20毫克沙丁胺醇持续雾化组；或d）40毫克沙丁胺醇持续雾化组（每组n = 5只动物）。所有组均接受静脉输注乳酸林格氏液，剂量为4 mL·kg-1·%烧伤（-1）·24小时-1进行复苏，并在整个48小时研究期间接受相同的机械通气。记录肺和心脏功能、肺淋巴流量、支气管阻塞评分以及肺湿/干重。
与生理盐水组和对照组相比，沙丁胺醇组在伤后48小时的吸气暂停和吸气峰值压力较低，肺血管内液体通量降低，Pao2/Fio2比值显著升高，分流分数降低。接受沙丁胺醇治疗的绵羊肺湿/干重比和支气管阻塞评分较低。
在烧伤合并烟雾吸入伤模型中，持续雾化吸入沙丁胺醇可通过改善气道清除和降低液体通量来改善肺功能。
