Effect of salbutamol during one-lung ventilation in patients with chronic obstructive pulmonary disease: a randomized...

Ventilation-perfusion mismatch during one-lung ventilation (OLV) for thoracic surgery increases the risk of hypoxemia. Salbutamol may selectively dilate pulmonary vessels and enhance perfusion of the ventilated lung. We sought to investigate whether selective salbutamol nebulization to the ventilated lung during OLV improves gas exchange and respiratory mechanics in patients with chronic obstructive pulmonary disease (COPD).

In this prospective randomized controlled trial, we randomly allocated 90 patients scheduled for lung resection to receive salbutamol or placebo nebulization 30 min after OLV initiation and analyzed 82 patients (41 per group). The primary endpoint was the change in the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO₂/F_IO₂) after nebulization. Secondary outcomes included other gas exchange and respiratory mechanics indices, hemodynamic variables, and perioperative complications.

Compared with placebo, salbutamol increased PaO₂/F_IO₂ (mean difference, 26; 95% confidence interval [CI], 0 to 53; P = 0.03) and decreased alveolar dead space (mean difference, -1.7; 95% CI, -4.3 to -0.1; P = 0.04) as well as serum potassium (mean difference, -0.2; 95% CI, -0.4 to 0.0; P = 0.01). Heart rate rose transiently without arrhythmia. In a subgroup of patients who had received preoperative inhaler therapy, no between-group differences were observed.

Selective salbutamol nebulization during OLV improved oxygenation and respiratory mechanics without serious adverse events, and it may be considered as an adjunctive option for the management of intraoperative hypoxemia in patients with COPD. The lack of benefit among patients who received preoperative inhaler therapy suggests that intraoperative selective one-lung nebulization may be more advantageous than preoperative two-lung nebulization.

ClinicalTrials.gov ( NCT05914285 ); first submitted 13 June 2023.