ARDS/ALI

A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury.

Crit Care Med. 2005 Aug;33(8):1681-1687

Martin GS, Moss M, Wheeler AP, Mealer M, Morris JA, Bernard GR.

From the Division of Pulmonary, Allergy and Critical Care, Department of Medicine (GSM, MMo, MMe), Emory University School of Medicine, Atlanta, GA; and Division of Allergy, Pulmonary, and Critical Care, Department of Medicine (APW, GRB), and Division of Trauma and Surgical Critical Care, Department of Surgical Sciences (JAM), Vanderbilt University School of Medicine, Nashville, TN.

OBJECTIVE:: Hypoproteinemia is a common condition in critically ill patients, associated with the development of acute lung injury and acute respiratory distress syndrome and subsequent worse clinical outcomes.

Albumin with furosemide benefits lung physiology in hypoproteinemic patients with acute lung injury/acute respiratory distress syndrome, but the independent pharmacologic effects of these drugs are unknown. DESIGN:: Randomized, double-blinded, placebo-controlled multicentered trial. SETTING:: Eleven medical, surgical, and trauma intensive care units including 190 beds within two university hospital systems. PATIENTS:: Forty mechanically ventilated patients with acute lung injury/acute respiratory distress syndrome, whose serum total protein concentrations were <6.0 g="" dl="" were="" included="" patients="" excluded="" for="" hemodynamic="" instability="" or="" significant="" renal="" hepatic="" failure="" interventions::="" subjects="" equally="" randomly="" allocated="" to="" receive="" furosemide="" with="" albumin="" placebo="" 72="" hrs="" titrated="" fluid="" loss="" and="" normalization="" of="" serum="" total="" protein="" concentration="" measurements="" main="" results::="" the="" primary="" outcome="" was="" change="" in="" oxygenation="" from="" baseline="" day="" 1="" secondary="" physiologic="" clinical="" outcomes="" there="" no="" differences="" characteristics="" relation="" group="" assignment="" albumin-treated="" had="" greater="" increases="" mean="" pao2="" fio2:="" 43="" vs="" -24="" mm="" hg="" at="" 24="" 49="" -13="" 3="" 5="" 0="" net="" -5480="" -1490="" ml="" throughout="" study="" period="" all="" p="" 05="" bolus="" administration="" control="" reduced="" negative="" balance="" more="" frequently="" developed="" hypotension="" fewer="" shock-free="" days="" which="" translated="" organ="" end="" conclusions::="" addition="" therapy="" hypoproteinemic="" acute="" lung="" injury="" respiratory="" distress="" syndrome="" significantly="" improves="" better="" maintenance="" stability="" additional="" randomized="" trials="" are="" necessary="" examine="" mechanisms="" determine="" effect="" on="" important="" such="" as="" duration="" mechanical="" ventilation="" br="">
PMID: 16096441 [PubMed - as supplied by publisher]