• Ernesto Lopez, Osamu Fujiwara, Francisco Lima-Lopez, Oscar E Suman, Ronald P Mlcak, Hal K Hawkins, Robert A Cox, David N Herndon, Donald S Prough, and Perenlei Enkhbaatar.
• 1Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX. 2Department of Surgery, University of Texas Medical Branch, and Shriners Hospital for Children, Galveston, TX. 3Department of Respiratory Care, University of Texas Medical Branch, and Shriners Hospital for Children, Galveston, TX. 4Department of Pathology, University of Texas Medical Branch, and Shriners Hospital for Children, Galveston, TX.
• Crit. Care Med. 2016 Feb 1; 44 (2): e89-96.

ObjectivesTo test the hypothesis that nebulized epinephrine ameliorates pulmonary dysfunction by dual action-bronchodilation (β2-adrenergic receptor agonism) and attenuation of airway hyperemia (α1-adrenergic receptor agonism) with minimal systemic effects.DesignRandomized, controlled, prospective, and large animal translational studies.SettingUniversity large animal ICU.SubjectsTwelve chronically instrumented sheep.InterventionsThe animals were exposed to 40% total body surface area third degree skin flame burn and 48 breaths of cooled cotton smoke inhalation under deep anesthesia and analgesia. The animals were then placed on a mechanical ventilator, fluid resuscitated, and monitored for 48 hours in a conscious state. After the injury, sheep were randomized into two groups: 1) epinephrine, nebulized with 4 mg of epinephrine every 4 hours starting 1 hour post injury, n = 6; or 2) saline, nebulized with saline in the same manner, n = 6.Measurements And Main ResultsTreatment with epinephrine had a significant reduction of the pulmonary transvascular fluid flux to water (p < 0.001) and protein (p < 0.05) when compared with saline treatment from 12 to 48 hours and 36 to 48 hours, respectively. Treatment with epinephrine also reduced the systemic accumulation of body fluids (p < 0.001) with a mean of 1,410 ± 560 mL at 48 hours compared with 3,284 ± 422 mL of the saline group. Hemoglobin levels were comparable between the groups. Changes in respiratory system dynamic compliance, mean airway pressure, PaO2/FiO2 ratio, and oxygenation index were also attenuated with epinephrine treatment. No considerable systemic effects were observed with epinephrine treatment.ConclusionsNebulized epinephrine should be considered for use in future clinical studies of patients with burns and smoke inhalation injury.

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