Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 184, Issue 5, Pages 561-568Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.201012-2090OC
Keywords
pulmonary edema; acute respiratory distress syndrome; alveolar epithelium
Categories
Funding
- National Heart, Lung, and Blood Institute [NO1-HR-56165-56713]
- AstraZeneca (AZ)
- Asthmatx
- CareFusion
- Phillips Healthcare
- Covidien Healthcare
- Abbott
- CMIC
- American Society of Nephrologists
- Averion International
- Mylan
- Posen
- Lilly
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Rationale: beta(2)-Adrenergic receptor agonists accelerate resolution of pulmonary edema in experimental and clinical studies. Objectives: This clinical trial was designed to test the hypothesis that an aerosolized beta(2)-agonist, albuterol, would improve clinical outcomes in patients with acute lung injury (ALI). Methods: We conducted a multicenter, randomized, placebo-controlled clinical trial in which 282 patients with ALI receiving mechanical ventilation were randomized to receive aerosolized albuterol (5 mg) or saline placebo every 4 hours for up to 10 days. The primary outcome variable for the trial was ventilator-free days. Measurements and Main Results: Ventilator-free days were not significantly different between the albuterol and placebo groups (means of 14.4 and 16.6 d, respectively; 95% confidence interval for the difference, -4.7 to 0.3 d; P = 0.087). Rates of death before hospital discharge were not significantly different between the albuterol and placebo groups (23.0 and 17.7%, respectively; 95% confidence interval for thedifference, -4.0 to 14.7%; P = 0.30). In the subset of patients with shock before randomization, the number of ventilator-free days was lower with albuterol, although mortality was not different. Overall, heart rates were significantly higher in the albuterol group by approximately 4 beats/minute in the first 2 days after randomization, but rates of new atrial fibrillation (10% in both groups) and other cardiac dysrhythmias were not significantly different. Conclusions: These results suggest that aerosolized albuterol does not improve clinical outcomes in patients with ALI. Routine use of beta(2)-agonist therapy in mechanically ventilated patients with ALI cannot be recommended.
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