Journal
INTENSIVE CARE MEDICINE
Volume 28, Issue 6, Pages 705-711Publisher
SPRINGER-VERLAG
DOI: 10.1007/s00134-002-1282-x
Keywords
adrenergic beta-agonists; albuterol; alveolar fluid clearance; pulmonary edema
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Funding
- NHLBI NIH HHS [HL 51856] Funding Source: Medline
- PHS HHS [K08 70521] Funding Source: Medline
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Objective: Experimental studies demonstrate that beta-adrenergic agonists markedly stimulate alveolar fluid clearance if concentrations of 10(-6) M are achieved in alveolar fluid. However, no studies have determined whether aerosolized beta-adrenergic agonists are delivered to the distal air spaces of the lung in therapeutic concentrations in patients with pulmonary edema. Design and setting: This retrospective study measured albuterol levels in the pulmonary edema fluid and plasma from mechanically ventilated patients with pulmonary edema from a hydrostatic mechanism (n=10) or from acute lung injury (n=12). Measurements and results: After a total aerosolized albuterol dose of 4.2 +/- 3.2 mg in the prior 6 h the median pulmonary edema fluid albuterol level was 1,250 ng/ml (10(-6) M) in patients with hydrostatic pulmonary edema; after 3.5 +/- 2.6 mg the figure was 1,240 ng/ml (10(-6) M) in patients with pulmonary edema from acute lung injury. Plasma albuterol levels were much lower, with a median of 5.2 ng/ml (0.0 1 x 10(-6) M) in patients with hydrostatic pulmonary edema and 3.1 ng/ml (0.01 x 10(-6) M) in patients with pulmonary edema from acute lung injury. Conclusions: These results provide the first evidence that levels of beta-adrenergic agonists that are physiologically efficacious in experimental models can be achieved with conventional delivery systems in ventilated, critically ill patients with acute respiratory failure from pulmonary edema.
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