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Early Treatment with Nebulised Salbutamol Worsens Physiological Measures and Does Not Improve Survival Following Phosgene Induced Acute Lung Injury
  1. C Grainge1,2,
  2. R Brown2,
  3. Mrs Bronwen Jugg2,
  4. AJ Smith2,
  5. TM Mann2,
  6. J Jenner2,
  7. P Rice2 and
  8. DA Parkhouse3
  1. 1Institute of Naval Medicine, Alverstoke, Hampshire
  2. 2Biomedical Sciences Department, Defence Science and Technology Laboratory, Porton Down, Salisbury, Wiltshire
  3. 3St Andrew’s Anaesthetic Department, St Andrew’s Burns Centre, Broomfield Hospital, Chelmsford, Essex
  1. Biomedical Sciences Department, Dstl Porton Down, Salisbury SP4 OJQ, UK +44 1980 613921 +44 1980 613741 bjjugg{at}dstl.gov.uk

Abstract

Objectives To examine the effectiveness of nebulised salbutamol in the treatment of phosgene induced acute lung injury.

Method Using previously validated methods, 12 anaesthetised large white pigs were exposed to phosgene (Ct 1978 ± 8 mg min m-3), established on mechanical ventilation and randomised to treatment with either nebulised salbutamol (2.5mg per dose) or saline control. Treatments were given 1, 5, 9, 13, 17 and 21 hours following phosgene exposure. The animals were followed to 24 hours following phosgene exposure.

Results Salbutamol treatment had no effect on mortality and had a deleterious effect on arterial oxygenation, shunt fraction and heart rate. There was a reduction in the number of neutrophils from 24.0% ± 4.4 to 12.17% ± 2.1 (p<0.05) in bronchoalveolar lavage, with some small decreases in inflammatory mediators in bronchoalveolar lavage but not in plasma.

Conclusion Nebulised salbutamol treatment following phosgene induced acute lung injury does not improve survival, and worsens various physiological parameters including arterial oxygen partial pressure and shunt fraction. Salbutamol treatment reduces neutrophil influx into the lung. Its sole use following phosgene exposure is not recommended.

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