Superior Effects of Nebulized Epinephrine to Nebulized Albuterol and Phenylephrine in Burn and Smoke Inhalation-Induced Acute Lung Injury.

Abstract

The severity of burn and smoke inhalation-induced acute lung injury (BSI-ALI) is associated with alveolar and interstitial edema, bronchospasm, and airway mucosal hyperemia. Previously, we have reported beneficial effects of epinephrine nebulization on BSI-ALI. However, the underlying mechanisms of salutary effects of nebulized epinephrine remain unclear. The present study compared the effects of epinephrine, phenylephrine, and albuterol on a model of BSI-ALI. We tested the hypothesis that both α1- and β2-agonist effects are required for ameliorating more efficiently the BSI-ALI. Forty percent of total body surface area, 3rd-degree cutaneous burn, and 48-breaths of cotton smoke inhalation were induced to 46 female Merino sheep. Postinjury, sheep were mechanically ventilated and cardiopulmonary hemodynamics were monitored for 48 h. Sheep were allocated into groups: control, n = 17; epinephrine, n = 11; phenylephrine, n = 6; and albuterol, n = 12. The drug nebulization began 1 h postinjury and was repeated every 4 h thereafter. In the results, epinephrine group significantly improved oxygenation compared to other groups, and significantly reduced pulmonary vascular permeability index, lung wet-to-dry weight ratio, and lung tissue growth factor-β1 level compared with albuterol and control groups. Epinephrine and phenylephrine groups significantly reduced trachea wet-to-dry weight ratio and lung vascular endothelial growth factor-A level compared with control group. Histopathologically, epinephrine group significantly reduced lung severity scores and preserved vascular endothelial-cadherin level in pulmonary arteries. In conclusion, the results of our studies suggest that nebulized epinephrine more effectively ameliorated the severity of BSI-ALI than albuterol or phenylephrine, possibly by its combined α1- and β2-agonist properties.

• Authors: Satoshi Fukuda, Ernesto Lopez, Koji Ihara, Yosuke Niimi, Clark R Andersen, Sam Jacob, Robert A Cox, Jose D Rojas, Donald S Prough, Perenlei Enkhbaatar
• Journal: Shock (Augusta, Ga.) (Shock) Vol. 54 Issue 6 Pg. 774-782 (12 2020) ISSN: 1540-0514 [Electronic] United States
• PMID: 32590700 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Phenylephrine
• Albuterol
• Epinephrine

Topics

• Acute Lung Injury (drug therapy, metabolism, pathology)
• Administration, Inhalation
• Albuterol (pharmacology)
• Animals
• Burns (drug therapy, metabolism, pathology)
• Epinephrine (pharmacology)
• Female
• Nebulizers and Vaporizers
• Phenylephrine (pharmacology)
• Sheep
• Smoke Inhalation Injury (drug therapy, metabolism, pathology)