Intervention: Albuterol Sulfate
Trial phase: Phase 2 | Phase 3
SMILES: CC(C)(C)NCC(O)c1ccc(O)c(CO)c1.CC(C)(C)NCC(O)c1ccc(O)c(CO)c1.O=S(=O)(O)O
Sex: All
Age groups: Child | Adult | Older Adult
Healthy volunteers: No
Participants at risk: 152
Group description: Aerosolized albuterol sulfate (5.0 mg dissolved in saline) every 4 hours
Eligibility criteria:
Inclusion Criteria:

Must meet the following three criteria within a 24-hour period:

Acute onset of PaO2/FiO2 less than or equal to 300 (adjustments made for altitude where appropriate)
Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph
Requirement for positive pressure ventilation via endotracheal tube
No clinical evidence of left-sided cardiac failure to account for bilateral pulmonary infiltrates

Exclusion Criteria:

Greater than 48 hours since all inclusion criteria are met
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