Randomized, Placebo-Controlled Trial of an Aerosolized Beta-2 Adrenergic Agonist (Albuterol) for the Treatment of Acute Lung Injury.

Matthay, MA; Brower, R. W.; Bt, Thompson; Schoenfeld, Daniel; Eisner,; Carson, Stephanie; Moss, Madelyn; Douglas, Ivor S.; Hite, Duncan; MacIntyre, Neil R.; Kd, Liu

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a2166

Cited by 93 publications

(173 citation statements)

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“…Three RCTs (646 patients) evaluated β-agonists in patients with ARDS [408][409][410]. In two of these trials, salbutamol (15 μg/kg of ideal body weight) delivered intravenously [408,409] was compared with placebo, while the third trial compared inhaled albuterol versus placebo [410]. Group allocation was blinded in all three trials, and two trials were stopped early for futility or harm [409][410][411].…”

Section: We Recommend Against the Use Of β-2 Agonists For The Treatmementioning

confidence: 99%

“…In two of these trials, salbutamol (15 μg/kg of ideal body weight) delivered intravenously [408,409] was compared with placebo, while the third trial compared inhaled albuterol versus placebo [410]. Group allocation was blinded in all three trials, and two trials were stopped early for futility or harm [409][410][411]. More than half of the patients enrolled in all three trials had pulmonary or non-pulmonary sepsis as the cause of ARDS.…”

Section: We Recommend Against the Use Of β-2 Agonists For The Treatmementioning

confidence: 99%

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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Recommend Against the Use Of β-2 Agonists For The Treatmementioning

confidence: 99%

Section: We Recommend Against the Use Of β-2 Agonists For The Treatmementioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Th is fi nding was associated with an upregulation of MMP-9 [18] and, therefore, with better alveolar epithelial repair [45]. Nevertheless, the route of administration could be relevant, as a recent trial has concluded that patients with ALI treated with inhaled salbutamol show no signifi cant improvement in clinical outcomes [46]. On the other hand, blockade of MMP-8 has shown benefi cial eff ects in experimental models of lung injury [22], including decreased lung fi brosis after bleomycin administration [23].…”

Section: Therapeutic Strategies Aimed At Lung Repairmentioning

confidence: 99%

Repair after Acute Lung Injury: Molecular Mechanisms and Therapeutic Opportunities

González-López¹,

Albaiceta²

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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BACKGROUND: The use of ␤ 2 agonist as an intervention for acute lung injury (ALI) and ARDS patients is controversial, so we performed a systematic review and meta-analysis of the published randomized controlled trials of using ␤ 2 agonists to improve outcomes (mortality and ventilator free days) among patients with ALI/ARDS. METHODS: A comprehensive search of 7 major databases (Ovid MEDLINE In-Process and other non-indexed citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus) for randomized controlled trials using ␤ 2 agonists for ALI from their origin to March 2013 was conducted. The effect size was measured by relative risk for dichotomous outcomes, and mean difference for continuous outcomes, with 95% CI. The statistical heterogeneity between the studies was assessed with the Cochran Q test and I 2 statistic. The heterogeneity of > 50% was considered significant for the analysis. The Cochrane risk of bias tool was used to ascertain the quality of the included studies. RESULTS: Out of 219 studies screened, 3 randomized controlled trials reported mortality and ventilator-free days, in 646 ALI/ ARDS subjects. Of the 646 subjects, 334 (51.7%) received ␤ 2 agonist and 312 (48.3%) received placebo. There was no significant decrease in 28-day mortality or hospital mortality in the ␤ 2 -agonist group: relative risk 1.04, 95% CI 0.50 -2.16, and relative risk 1.22, 95% CI 0.95-1.56, respectively. The ventilator-free days and organ-failure-free days were significantly lower for the ALI subjects who received ␤ 2 agonists: mean difference ؊2.19 days (95% CI ؊3.68 to ؊1.99 d) and mean difference ؊2.04 days (95% CI ؊3.74 to ؊0.35 d), respectively. CONCLUSIONS: In subjects with ALI/ARDS, ␤ 2 agonists were not only nonbeneficial in improving the survival, but were harmful and increased morbidity (reduced organ-failure-free days and ventilator-free days). The current evidence discourages the use of ␤ 2 agonist in ALI/ARDS patients. (International Prospective Register of Systematic Reviews, http://www.crd.york.ac.uk/prospero, 2012:CRD42012002616.)

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Randomized, Placebo-Controlled Trial of an Aerosolized Beta-2 Adrenergic Agonist (Albuterol) for the Treatment of Acute Lung Injury.

Cited by 93 publications

References 0 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Repair after Acute Lung Injury: Molecular Mechanisms and Therapeutic Opportunities

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

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Randomized, Placebo-Controlled Trial of an Aerosolized Beta-2 Adrenergic Agonist (Albuterol) for the Treatment of Acute Lung Injury.

Cited by 93 publications

References 0 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Repair after Acute Lung Injury: Molecular Mechanisms and Therapeutic Opportunities

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

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