Randomized, Placebo-controlled Clinical Trial of an Aerosolized β2-Agonist for Treatment of Acute Lung Injury

被引：335

作者：

Matthay, Michael A. ^{[1
]}

Brower, Roy G. ^{[2
]}

Carson, Shannon ^{[3
]}

Douglas, Ivor S. ^{[3
]}

Eisner, Mark ^{[4
]}

Hite, Duncan ^{[3
]}

Holets, Steven ^{[5
]}

Kallet, Richard H. ^{[6
]}

Liu, Kathleen D.

MacIntyre, Neil ^{[7
]}

Moss, Marc ^{[8
]}

Schoenfeld, David ^{[9
]}

Steingrub, Jay ^{[10
]}

Thompson, B. Taylor ^{[9
]}

Hudson, L. ^{[11
]}

Hough, C. ^{[11
]}

Neff, M. ^{[11
]}

Sims, K. ^{[11
]}

Watkins, T. ^{[11
]}

Steingrub, J. ^{[10
]}

Tidswell, M. ^{[10
]}

DeSouza, L. ^{[10
]}

Kardos, C. ^{[10
]}

Kozikowski, L. ^{[10
]}

Kozikowski, K. ^{[10
]}

Guntupalli, K. ^{[12
]}

Bandi, V. ^{[12
]}

Pope, C. ^{[12
]}

Brower, R. ^{[13
]}

Fessler, H. ^{[13
]}

Hager, D. ^{[13
]}

Mendez-Tellez, P. ^{[13
]}

Oakjones, K. ^{[13
]}

Needham, D. ^{[13
]}

Sevransky, J.

Workneh, A.

Han, S.

Murray, S.

Shanholtz, C. ^{[14
]}

Netzer, G. ^{[14
]}

Rock, P. ^{[14
]}

Sampaio, A. ^{[14
]}

Titus, J. ^{[14
]}

Harrington, T. ^{[14
]}

Herr, D. ^{[15
]}

Lee, B. ^{[15
]}

Bolouri, N. ^{[15
]}

Wiedemann, H. P. ^{[16
]}

Ashton, R. W. ^{[16
]}

Culver, D. A. ^{[16
]}

机构：

[1] Univ Calif San Francisco, Cardiovasc Res Inst, San Francisco, CA 94143 USA

[2] Johns Hopkins Univ, Baltimore, MD USA

[3] Univ N Carolina, Chapel Hill, NC USA

[4] Genentech Inc, San Francisco, CA USA

[5] Mayo Clin, Rochester, MN USA

[6] San Francisco Gen Hosp, San Francisco, CA 94110 USA

[7] Duke Univ, Durham, NC USA

[8] Univ Colorado, Denver, CO 80202 USA

[9] Massachusetts Gen Hosp, Boston, MA 02114 USA

[10] Baystate Med Ctr, Springfield, MA USA

[11] Univ Washington, Harborview, WA USA

[12] Baylor Coll Med, Houston, TX 77030 USA

[13] Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA

[14] Univ Maryland, College Pk, MD 20742 USA

[15] Washington Hosp Ctr, Washington, DC USA

[16] Cleveland Clin Fdn, Cleveland, OH USA

[17] Univ Hosp Cleveland, Cleveland, OH 44106 USA

[18] Denver Hlth Med Ctr, Denver, CO USA

[19] Vanderbilt Univ, Nashville, TN USA

[20] Wake Forest Univ, Winston Salem, NC 27109 USA

[21] Univ Virginia, Charlottesville, VA 22903 USA

[22] Univ Calif San Francisco, Fresno, CA USA

[23] Univ Calif Davis, Davis, CA USA

[24] Louisiana State Univ, Baton Rouge, LA 70803 USA

[25] Baton Rouge Gen Med Ctr Mid City, Baton Rouge, LA USA

[26] Baton Rouge Gen Med Ctr Bluebonnet, Baton Rouge, LA USA

[27] Tulane Univ, New Orleans, LA 70118 USA

[28] Massachusetts Gen Hosp, Clin Coordinating Ctr, Boston, MA 02114 USA

[29] Harvard Univ, Sch Med, Cambridge, MA 02138 USA

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2011年 / 184卷 / 05期

关键词：

pulmonary edema; acute respiratory distress syndrome; alveolar epithelium; RESPIRATORY-DISTRESS-SYNDROME; ALVEOLAR FLUID CLEARANCE; PULMONARY-EDEMA FLUID; BETA(2)-ADRENERGIC RECEPTOR; EPITHELIAL TRANSPORT; DECREASES EXPRESSION; VENTILATED PATIENTS; RAT LUNGS; PROGRESS; CELLS;

D O I：

10.1164/rccm.201012-2090OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：561 / 568

页数：8

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