Albuterol in the treatment of acute respiratory distress syndrome: A meta-analysis of randomized controlled trials

doi:10.5847/wjem.j.1920-8642.2015.03.001

Abstract

Abstract:

BACKGROUND: This meta-analysis of randomized controlled trials aimed to systematically evaluate the value of albuterol in the treatment of patients with acute respiratory distress syndrome (ARDS).
DATA SOURCES: Randomized controlled trials on albuterol treatment of ARDS from its inception to October 2014 were searched systematically. The databases searched included: PubMed, Ovid EMBASE, Ovid Cochrane, CNKI, WANFANG and VIP. The trials were screened according to the pre-designed inclusion and exclusion criteria. We performed a systematic review and meta-analysis of the randomized controlled trials (RCTs) on albuterol treatment, attempting to improve outcomes, i.e. lowering the 28-day mortality and ventilator-free days.
RESULTS: Three RCTs involving 646 patients met the inclusion criteria. There was no significant decrease in the 28-day mortality (risk difference=0.09; P=0.07, P for heterogeneity=0.22, I²=33%). The ventilator-free days and organ failure-free days were significantly lower in the patients who received albuterol (mean difference=-2.20; P<0.001, Pfor heterogeneity=0.49, I²=0% and mean difference=-1.71, P<0.001, P for heterogeneity=0.60, I²=0%).
CONCLUSIONS: Current evidences indicate that treatment with albuterol in the early course of ARDS was not effective in increasing the survival, but significantly decreasing the ventilator-free days and organ failure-free days. Owing to the limited number of included trails, strong recommendations cannot be made.

Key words: Albuterol, Acute respiratory distress syndrome, Mortality, Ventilator-free days

Ruo Wu, Shi-yun Lin, Hui-min Zhao. Albuterol in the treatment of acute respiratory distress syndrome: A meta-analysis of randomized controlled trials[J]. World Journal of Emergency Medicine, 2015, 6(3): 165-171.

Figures/Tables 5

Table 1

Figure 1.

Table 2

Figure 2.

Figure 3.

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ID	Key words
#1	acute lung injury [MeSH terms]
#2	ALI [Title/Abstract]
#3	acute respiratory distress syndrome [MeSH terms]
#4	ARDS [Title/Abstract]
#5	adult respiratory distress syndrome [MeSH terms]
#6	#1 OR #2 OR #3 OR #4 OR #5
#7	salbutamol [MeSH terms]
#8	albuterol [MeSH terms]
#9	#7 OR #8
#10	#6 AND #9
#11	randomized controlled trial [Publication type]
#12	controlled clinical trial [Publication type]
#13	randomized [Title/Abstract]
#14	placebo [Title/Abstract]
#15	randomly [Title/Abstract]
#16	trial [Title/Abstract]
#17	groups [Title/Abstract]
#18	#11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17
#19	#10 AND #18

Variables	Perkins GD^[26]		Matthay MA^[27]		Gao Smith F^[28]
Year published	2006		2011		2012
Setting	Single center		Multi-center		Multi-center
Route for intervention	Intravenous		Inhaled		Intravenous
Outcome definition	Primary outcome: extravascular lung water reduction in the salbutamol group at day 7		Primary outcome: number of ventilator-free days from randomization to day 28		Primary outcome: 28-day mortality
Number of subjects	19	21	152	130	161	163
Age (year)	68.7±16.0	57.0±14.7	5 2±16	51±16	55.8±17.2	54.2±17.5
PaO₂/FiO₂ (mmHg)	117±49.5	102.8±36.8	170±84	171±75	103.5±36.8	103.5±36.8
APACHE II score	24.9±6.4	22.5±6.5	NA	NA	19.5±6.2	18.9±6.7
APACHE III score	NA	NA	94.1±28.7	91.5±29.6	NA	NA
28-day mortality (n, %)	11 (58)	14 (66)	NA	NA	55 (34)	38 (23)
Organ-failure-free days (days)	NA	NA	14.2±0.9	15.9±1.0	16.2±10.7	18.5±9.8
Ventilator-free days (days)	6.2±8.9	5.3±8.6	14.4±0.9	16.6±0.9	8.5±8.8	11.1±9.3
Tachycardia	5	2	12	4	23	2
Arrhythmias	5	2	15	13	14	3

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