Pro: β-Agonists in Acute Lung Injury—the End of the Story?

β-agonists for ARDS: the dark side of adrenergic stimulation?

“… 6 , 7 Thus, the findings consistently indicate harm from intravenous salbutamol at the dose studied (15 μg/kg ideal weight per h), but do not provide a clear mechanism. The findings are in line with the acute lung injury (ALTA) trial 8 of aerosolised salbutamol, which stopped early for futility with numerically lower ventilator-free days (p=0·087) and a significant reduction in days free of care in an intensive-care unit (p=0·023).…”

“…Possible explanations for harmful pulmonary effects have been reviewed. 8 , 9 Prolonged administration of β-agonists might downregulate β-receptors in lung epithelia and impair fluid removal. β-agonists could have a differential effect on the endothelium (harmful) versus the epithelium (beneficial if functional), and β-2 agonists could increase cardiac output thus aggravating alveolar capillary leak.…”

β2Agonist for the Treatment of Acute Lung Injury: A Systematic Review and Meta-analysis

“…Lack of consensus about using ␤ 2 agonists in the treatment of ALI/ ARDS patients represents one of the growing controversial issues in the critical care community. 6,[8][9][10][11] This challenging topic has been addressed in physiologic studies [12][13][14][15] and randomized controlled trials (RCTs) [16][17][18] However, 2 of the RCTs (the Aerosolized ␤ 2 Agonist for Treatment of Acute Lung Injury 16 [ALTA] trial, and the second ␤ Agonist Lung Injury trial 17 ) were stopped early because of futility and patient intolerance of the ␤ 2 agonists. Therefore, we performed a systematic review and meta-analysis of the published RCTs, on the effects of ␤ 2 agonists on hospital mortality, 28-day mortality, and ventilator free-days in patients with ALI/ARDS.…”