Document Detail


Preclinical evaluation of epinephrine nebulization to reduce airway hyperemia and improve oxygenation after smoke inhalation injury.
MedLine Citation:
PMID:  21263320     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Acute lung injury secondary to smoke inhalation is a major source of morbidity and mortality in burn patients. We tested the hypothesis that nebulized epinephrine would ameliorate pulmonary dysfunction secondary to acute lung injury by reducing airway hyperemia and edema formation and mediating bronchodilatation in an established, large animal model of inhalation injury.
DESIGN: Prospective, controlled, randomized trial.
SETTING: University research laboratory.
SUBJECTS: Twenty-four chronically instrumented, adult, female sheep.
INTERVENTIONS: Following baseline measurements, the animals were allocated to a sham-injured group (n = 5), an injured and saline-treated group (n = 6), or an injured group treated with 4 mg of nebulized epinephrine every 4 hrs (n = 6). Inhalation injury was induced by 48 breaths of cotton smoke. The dose of epinephrine was derived from dose finding experiments (n = 7 sheep).
MEASUREMENTS AND MAIN RESULTS: The injury induced significant increases in airway blood flows, bronchial wet/dry weight ratio, airway obstruction scores, ventilatory pressures, and lung malondialdehyde content, and contributed to severe pulmonary dysfunction as evidenced by a significant decline in Pao₂/Fio₂ ratio and increase in pulmonary shunt fraction. Nebulization of epinephrine significantly reduced tracheal and main bronchial blood flows, ventilatory pressures, and lung malondialdehyde content. The treatment was further associated with significant improvements of Pao₂/FIO₂ ratio and pulmonary shunting.
CONCLUSIONS: Nebulization of epinephrine reduces airway blood flow and attenuates pulmonary dysfunction in sheep subjected to severe smoke inhalation injury. Future studies will have to improve the understanding of the underlying pathomechanisms and identify the optimal dosing for the treatment of patients with this injury.
Authors:
Matthias Lange; Atsumori Hamahata; Daniel L Traber; Robert A Cox; Gabriela A Kulp; Yoshimitsu Nakano; Lillian D Traber; David N Herndon; Perenlei Enkhbaatar
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-07-29     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  718-24     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Disease Models, Animal
Dose-Response Relationship, Drug
Epinephrine / administration & dosage,  therapeutic use*
Female
Hemodynamics / drug effects
Hyperemia / drug therapy*,  etiology
Nebulizers and Vaporizers
Pulmonary Circulation / drug effects
Pulmonary Edema / drug therapy,  etiology
Pulmonary Gas Exchange / drug effects
Sheep
Smoke Inhalation Injury / complications,  drug therapy*
Grant Support
ID/Acronym/Agency:
GM60915/GM/NIGMS NIH HHS; P01 GM066312/GM/NIGMS NIH HHS; P012 GM066312/GM/NIGMS NIH HHS; R01 GM060688/GM/NIGMS NIH HHS; R01 GM060688/GM/NIGMS NIH HHS
Chemical
Reg. No./Substance:
YKH834O4BH/Epinephrine
Comments/Corrections
Comment In:
Crit Care Med. 2011 Apr;39(4):891-3   [PMID:  21613840 ]
Crit Care Med. 2012 Jan;40(1):355-6; author reply 356-7   [PMID:  22179383 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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