Inhaled Beta-2 Agonist Therapy in Moderate-To-Severe ARDS: A Multi-Center Retrospective Cohort Study
Scott A, and Ouellette D. INHALED BETA-2 AGONIST THERAPY IN MODERATE-TO-SEVERE ARDS: A MULTI-CENTER RETROSPECTIVE COHORT STUDY. Chest 2019; 156(4):A1668.
SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Conflicting data confound the relationship between beta-2 agonist use and patient outcomes in acute respiratory distress syndrome (ARDS). Several studies note improved surrogate outcomes. A 2006 chart review found a survival benefit with high-dose inhaled salbutamol in mild ARDS. BALTI-2 was terminated prematurely due to increased mortality with intravenous salbutamol. ALTA found no significant difference in mortality or ventilator-free days (VFD) with aerosolized albuterol treatment in mild ARDS. Beta-2 agonist use in ARDS is ubiquitous; in a 2013 survey of 33 British and 54 Chinese ICUs, ARDS was reported as the indication for beta-2 agonist use in roughly 10% of patients. The aim of our multi-center, retrospective cohort study is to examine the relationship between patient-centered outcomes and use of albuterol in ARDS. METHODS: Data were collected from five Southeast Michigan hospitals. An 1195-patient list was created using an electronic health record, with a diagnosis of “acute respiratory distress” and/or “acute respiratory distress syndrome” and a hospital encounter between 12/1/2012 and 2/10/2018. Patients under age 18 years and those not meeting the Berlin criteria for moderate or severe ARDS were excluded, leaving 464 adults. Patients transferred to or from an external institution during treatment were excluded. Demographics, ARDS triggers, bronchodilator treatment, and outcomes of interest were recorded for the remaining 312 patients. RESULTS: The mean PaO2/FiO2 ratio (P:F) was 85.2+/-37.0, age 55.73+/-17.15 years, and in-hospital mortality rate 44.2%. 260 patients received bronchodilators (83.3%). No statistically significant difference in mortality (p=0.359), P:F (p=0.881), age (p=0.288), gender (p=0.647), VFD (p=0.415), maximum heart rate (p=0.444), or potassium nadir (p=0.740) distinguished patients treated with bronchodilators from those who were not. With multivariate analysis, independent factors associated with increased mortality include increased age (p=0.000, OR=1.039), increased maximum heart rate (p=0.000, OR=1.023), and decreased P:F (p=0.001, OR=0.987). Independent factors associated with improved survival include a higher cumulative dose of albuterol (p=0.001, OR=0.997) and lower potassium nadir (p=0.001, OR=2.713). The average per patient total cost of bronchodilator therapy was $330.17. CONCLUSIONS: Most patients received bronchodilators. Higher cumulative doses of inhaled albuterol are strongly and independently associated with a survival benefit in our patients with moderate-to-severe ARDS. Factors associated with increased mortality include decreased P:F and increased age, maximum heart rate, and potassium nadir. Adverse effects of bronchodilator therapy appear infrequent and costs modest. CLINICAL IMPLICATIONS: Inhaled albuterol may benefit patients with moderate-to-severe ARDS in a dose-dependent fashion. Inhaled albuterol has a low risk profile and modest cost.