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Published ahead of print on October 27, 2005, doi:10.1164/rccm.200508-1302OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 3, February 2006, 281-287

A more recent version of this article appeared on February 1, 2006
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Submitted on August 22, 2005
Accepted on October 27, 2005

The Beta Agonist Lung Injury Trial (BALTI) a randomised placebo controlled clinical trial

Gavin D Perkins1*, Daniel F McAuley2, David R Thickett3, and Fang Gao4

1 Department of Intensive Care Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom; Division of Medical Sciences, University of Birmingham, Birmingham, United Kingdom, 2 Department of Intensive Care Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom; Department of Intensive Care Medicine, Queen's University of Belfast, Belfast, United Kingdom, 3 Division of Medical Sciences, University of Birmingham, Birmingham, United Kingdom, 4 Department of Intensive Care Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom

* To whom correspondence should be addressed. 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 oedema and improve survival. Objective: To determine if a sustained infusion of the intravenous salbutamol (albuterol) would accelerate the resolution of alveolar oedema in adult patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Methods: This was a single centre double blind, randomised controlled trial. Patients with ALI/ARDS were randomised to treatment with intravenous salbutmaol (15 µg kg-1 hr-1) or placebo for 7 days. The primary end-point was extra vascular lung water measured by thermodilution (PiCCOTM) at day 7. Measurements and main results: Sixty-six patients were screened of which 40 met the inclusion criteria and were enrolled during 2001-03. 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 0.2-8.3ml kg-1, P=0.038. Plateau airway pressure was lower at day 7 in the salbutamol group 23.9 (3.8)cm H20 vs placebo 29.5(7.2)cm H20, P=0.049. There was a trends towards lower Murray lung injury at day 7 in the salbutamol group 1.7(0.9) vs 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 an intravenous {beta} agonists, reduces extravascular lung water.
Key words: Respiratory Distress Syndrome, Adult; Albuterol; Extravascular Lung Water; Pulmonary edema;




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