Drug Study of Albuterol to Treat Acute Lung Injury

Inclusion Criteria

• •Must meet the following three criteria within a 24-hour period:
• •1. Acute onset of PaO2/FiO2 less than or equal to 300 (adjustments made for altitude where appropriate)
• •2. Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph
• •3. Requirement for positive pressure ventilation via endotracheal tube
• •No clinical evidence of left-sided cardiac failure to account for bilateral pulmonary infiltrates
• •Neuromuscular disease that impairs ability to ventilate without assistance, (e.g., cervical spinal cord injury at level C5 or higher spinal cord injury amyotrophic lateral sclerosis, Guillain-Barré syndrome or myasthenia gravis)
• •Pregnant or breast-feeding
• •Severe chronic respiratory disease (i.e., chronic hypercapnia \[PaCO2 greater than 45 mmHg\], chronic hypoxemia \[PaO2 less than 55 mmHg on FiO2 = 0.21\], hospitalization within the last 6 months for respiratory failure \[PaCO2 greater than 50 mm Hg and/or PaO2 less than 55 mmHg on 0.21 FiO2\], secondary polycythemia, severe pulmonary hypertension \[mean PAP (pulmonary artery pressure) greater than 40 mmHg\], or ventilator dependency)
• •Burns over greater than 40% of total body surface area
• •Cancer or other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%
• •Allogeneic bone marrow transplant within the 5 years prior to study entry
• •Participant, surrogate, or physician is not committed to full support (Exception: a participant will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest)
• •Severe chronic liver disease (Child-Pugh score of 11-15)
• •Diffuse alveolar hemorrhage from vasculitis
• •Morbid obesity (greater than 1kg/cm body weight.)
• •Unwillingness or inability to utilize the ARDS network 6 ml / kg Predicted Body Weight (PBW) ventilation protocol
• •Moribund participant and is not expected to survive 24 hours
• •No intent to obtain central venous access for monitoring intravascular pressures
• •Contraindication to aerosolized albuterol (see Appendix A.8 of the protocol for more information)
• •Daily use (prior to study hospitalization) of inhaled beta agonist, corticosteroid, or oral leukotriene modifier
• •Unwillingness of primary physician to discontinue inpatient beta agonist use
• •Acute myocardial infarction or acute coronary syndrome within 30 days of study entry
• •Severe congestive heart failure (see Appendix A5 of the protocol for more information)
• •Participation in other experimental medication trial within 30 days of study entry with the exception of the ARDSNet pharmaconutrient nutrition trial (OMEGA)
• •Heart rate greater than 85% of maximal predicted heart rate (MHR85) as calculated by MHR85 = 85% x (220-age)
• •Currently receiving high frequency ventilation