Abstract

BackgroundThe Acute Respiratory Distress Syndrome (ARDS) is a common cause of respiratory failure in critically ill patients. Experimental studies suggest that treatment with beta agonists may be helpful in ARDS. The Beta Agonist Lung Injury TrIal (BALTI-2) is a multicentre, pragmatic, randomised, double-blind, placebo-controlled clinical trial which aims to determine if sustained treatment with intravenous (IV) salbutamol will improve survival in ARDS.Methods/DesignPatients fulfilling the American-European Consensus Conference Definition of ARDS will be randomised in a 1:1 ratio to receive an IV infusion either of salbutamol (15 μg kg ideal body weight-1 hr-1) or placebo (0.9% sodium chloride solution), for a maximum of seven days. Allocation to randomised groups will use minimisation to ensure balance with respect to hospital of recruitment, age group (<64, 65-84, >85 years) and PaO2/FiO2 ratio (≤6.7, 6.8- 13.2, ≥13.3 kPa). Data will be recorded by participating ICUs until hospital discharge, and all surviving patients will be followed up by post at six and twelve months post randomisation. The primary outcome is mortality at 28 days after randomisation; secondary outcomes are mortality in ICU, mortality in hospital, number of ventilator-free days, number of organ failure-free days, mortality at twelve months post-randomisation, quality of life at six and twelve months, length of stay in ICU, length of stay in hospital, adverse effects (tachycardia, arrhythmia or other side effects sufficient to stop treatment drug). 1,334 patients will be recruited from about fifty ICUs in the UK. An economic evaluation will be conducted alongside the trial.Trial RegistrationCurrent Controlled Trials ISRCTN38366450.

Highlights

  • The Acute Respiratory Distress Syndrome (ARDS) is a common cause of respiratory failure in critically ill patients

  • The acute respiratory distress syndrome (ARDS) is a condition characterised by a failure of pulmonary oxygen exchange due to increased alveolar-capillary permeability and resultant lung oedema [1]

  • ARDS is defined by the 1994 AmericanEuropean Consensus Conference [2] as the acute onset of hypoxaemia (PaO2:FiO2 ratio of < 200mm Hg), bilateral infiltrates on a chest radiograph in the absence of cardiogenic causes of pulmonary oedema

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Summary

Introduction

The Acute Respiratory Distress Syndrome (ARDS) is a common cause of respiratory failure in critically ill patients. The BALTI-2 trial was conceived to test the hypothesis that sustained treatment with intravenous beta agonists in ARDS would improve 28 day mortality and other clinical and cost effectiveness outcomes.

Results
Conclusion
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