Randomized, placebo-controlled clinical trial of an aerosolized β₂-agonist for treatment of acute lung injury.

Pubmed ID: 21562125

Pubmed Central ID: PMC3175548

Journal: American journal of respiratory and critical care medicine

Publication Date: Sept. 1, 2011

MeSH Terms: Humans, Male, Female, United States, Middle Aged, Treatment Outcome, Follow-Up Studies, Survival Rate, Retrospective Studies, Double-Blind Method, Enzyme-Linked Immunosorbent Assay, Respiration, Artificial, Disease-Free Survival, Acute Lung Injury, Dose-Response Relationship, Drug, Drug Administration Schedule, Administration, Inhalation, Adrenergic beta-2 Receptor Agonists, Albuterol

Grants: N01-HR-56165-56713, N01HR56165

Authors: Ahmed A, Liu K, Thompson BT, deBoisblanc B, Matthay MA, Connors A, Hite D, Harabin A, Ringwood N, Oldmixon C, Morse R, Hudson L, Neff M, Sims K, Shanholtz C, Brower R, Fessler H, Murray S, Haney D, Douglas I, MacIntyre N, MacIntyre N, Govert J, Brown L, Knudsen N, Gentile M, Rock P, Carson S, Carson S, Bernard G, Rice T, Moss M, Moss M, Brower RG, Liu KD, Wheeler A, Schoenfeld D, Schoenfeld D, Johnson E, Douglas IS, Wright P, Spragg R, Waclawiw M, Parsons P, Komara J, Hejal R, Bost T, Morris A, Grissom C, Weaver L, Orme J, Clemmer T, Lawton C, Hanselman D, Sundar K, Hill T, Ludwig K, Eisner M, Eisner M, Daniel B, Garcia O, Kallet R, Peterson M, Guntupalli K, Bandi V, Pope C, Steingrub J, Steingrub J, Tidswell M, Kozikowski L, Hunt J, Lauto P, Meyaski G, Romaine C, Brierre S, LeBlanc C, Taylor D, Simeone F, Morris P, Howard A, McLean J, Rawal B, Sevransky J, Thomas F, Slutsky A, Lee B, Zhou H, Cox C, Lewis J, Thompson K, Holets S, Holets S, Kallet RH, Hough C, Watkins T, DeSouza L, Kardos C, Kozikowski K, Hager D, Mendez-Tellez P, Oakjones K, Needham D, Workneh A, Han S, Netzer G, Sampaio A, Titus J, Harrington T, Herr D, Bolouri N, Wiedemann H, Ashton R, Culver D, Frederick T, Guzman J, Reddy A, Andrews M, Lasalvia S, Thornton J, Warren E, Benson A, Burnham E, Clark B, Gray L, Higgins C, Maloney B, Mealer M, Frankel S, Dennen P, Hodgin K, Overdier K, Wolken R, Chang L, Lanier J, Hays M, Mogan S, Hite R, Harvey A, Bender K, Gross S, Overton A, Truwit J, Enfield K, Marshall M, Zenger M, Krueger J, Austin A, Dean N, Hirshberg E, Kumar N, Miller R, Napoli L, Pandita S, Schreiber G, Struck L, Thomsen G, Leung F, Kim P, Fujii T, Baughman J, Kerwin B, Alward W, Campbell E, Nielsen D, Pearce M, Matthay M, Calfee C, Kordesch K, Blaauw J, Albertson T, Vlastelin E, Hubmayr R, Brown D, Gajic O, Hinds R, Kor D, Passe M, Marr A, Long EK, Jain S, Seoane L, Fearon J, Duchesne J, Aquino M, Dorer D, Guha M, Hammond E, Lavery N, Lazar P, Molina I, Shui A, Smoot E, Thompson B, Bredow S, Weinmann G, Levy M, Markovitz B, Petkova E, Weijer C, Sznajder J, Begg M, Israel E

Cite As: National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, Holets S, Kallet RH, Liu KD, MacIntyre N, Moss M, Schoenfeld D, Steingrub J, Thompson BT. Randomized, placebo-controlled clinical trial of an aerosolized β₂-agonist for treatment of acute lung injury. Am J Respir Crit Care Med 2011 Sep 1;184(5):561-8.

Studies:

Abstract

RATIONALE: β₂-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 β₂-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 the difference,-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 β₂-agonist therapy in mechanically ventilated patients with ALI cannot be recommended. Clinical trial registered with www.clinicaltrials.gov (NCT 00434993).