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beta2 adrenergic agonists in acute lung injury? The heart of the matter

Jae W Lee1

  • 1Departments of Anesthesiology and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA. leejw@anesthesia.ucsf.edu

Critical Care (London, England)
|December 19, 2009
PubMed

Insights

Beta2 adrenergic agonists may worsen acute lung injury (ALI) by increasing lung endothelial permeability. This finding helps explain conflicting clinical trial results for ALI/ARDS patients treated with these drugs.

Area of Science:

  • Pulmonary Medicine
  • Critical Care Medicine
  • Pharmacology

Background:

  • Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has high mortality and lacks effective treatments.
  • Beta2 adrenergic agonists show potential for resolving pulmonary edema but clinical trial results are conflicting.

Purpose of the Study:

  • To investigate the mechanism behind conflicting beta2 adrenergic agonist trial results in ALI/ARDS.
  • To determine if beta agonists affect lung endothelial permeability in ALI.

Main Methods:

  • Utilized an oleic acid-induced lung injury model in dogs.
  • Assessed the effects of beta agonists on pulmonary capillaries and lung endothelial permeability.

Main Results:

  • The inotropic effect of beta agonists was shown to recruit damaged pulmonary capillaries.
  • This recruitment led to increased lung endothelial permeability in the context of ALI.

Conclusions:

  • Beta2 adrenergic agonists may exacerbate ALI by increasing lung endothelial permeability.
  • This mechanism could explain the inconsistent clinical outcomes observed with beta agonist therapy for ALI/ARDS.

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