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Published ahead of print on October 27, 2005, doi:10.1164/rccm.200508-1302OC
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American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 281-287, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200508-1302OC

Original Article

The beta-Agonist Lung Injury Trial (BALTI)

A Randomized Placebo-controlled Clinical Trial

Gavin D. Perkins, Daniel F. McAuley, David R. Thickett and Fang Gao

Department of Intensive Care Medicine, Birmingham Heartlands Hospital; Division of Medical Sciences, University of Birmingham, Birmingham; and Department of Intensive Care Medicine, Queen's University of Belfast, Belfast, United Kingdom

Correspondence and requests for reprints should be addressed to G. D. Perkins, M.B.Ch.B., Division of Medical Sciences, University of Birmingham, Birmingham B15 2TT, UK. E-mail: gavin.perkins{at}virgin.net

Rationale: Experimental data suggest that manipulation of alveolar fluid clearance with beta-agonists can accelerate the resolution of alveolar edema and improve survival.

Objective: To determine if a sustained infusion of intravenous salbutamol (albuterol) would accelerate the resolution of alveolar edema in adult patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Methods: This was a single-center, double-blind, randomized controlled trial. Patients with ALI/ARDS were randomized to treatment with intravenous salbutamol (15 µg kg–1 h–1) or placebo for 7 d. The primary endpoint was extravascular lung water measured by thermodilution (PiCCO) at Day 7.

Measurements and Main Results: Sixty-six patients were screened; of these, 40 met the inclusion criteria and were enrolled during 2001–2003. Patients in the salbutamol group had significantly lower lung water at Day 7 than the placebo group (9.2 ± 6 vs. 13.2 ± 3 ml kg–1; 95% confidence interval difference, 0.2–8.3 ml kg–1; p = 0.038). Plateau airway pressure was lower at Day 7 in the salbutamol group (23.9 ± 3.8 cm H2O) versus placebo (29.5 ± 7.2 cm H2O; p = 0.049). There was a trend toward lower Murray lung injury score at Day 7 in the salbutamol group (1.7 ± 0.9) versus placebo (2.0 ± 0.6; p = 0.2). Patients in the salbutamol group had a higher incidence of supraventricular arrhythmias (26 vs. 10%; p = 0.2).

Conclusion: Although further research is required to confirm the efficacy and safety of intravenous salbutamol in ALI/ARDS, this trial provides the first proof of principle that, in humans with ALI/ARDS, sustained treatment with intravenous beta-agonists reduces extravascular lung water.

Key Words: adrenergic beta-agonists • adult respiratory distress syndrome • albuterol • extravascular lung water • pulmonary edema




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