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| ID | Type | Description | Link |
|---|---|---|---|
| N01HR056179 | U.S. NIH Grant/Contract | View source | |
| HHSN268200536179C |
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Stopped for futility by DSMB
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Acute Respiratory Distress Syndrome (ARDS) and a lesser condition that occurs prior to ARDS, Acute Lung Injury (ALI), are medical conditions that occur when there is severe inflammation and increased fluids (edema) in both lungs, making it hard for the lungs to function properly. Patients with these conditions require treatment that includes the use of a breathing machine (ventilator). The purpose of this study is to find out whether giving albuterol (a drug commonly used in asthmatics) or not giving albuterol to patients with ALI or ARDS makes a difference in how long it takes for a patient to be able to breath without the ventilator.
Aerosolized beta-2 agonist therapy is anticipated to diminish the formation of lung edema, enhance clearance of lung edema and decrease pulmonary inflammation in patients with acute lung injury. Because beta-2 agonists have been shown to reduce permeability induced lung injury, it is anticipated that the severity of lung injury will be reduced by aerosolized beta-2 agonist therapy. The therapy may work by enhancing resolution of pulmonary edema by upregulating alveolar epithelial fluid transport mechanisms that will in turn enhance the clearance of alveolar edema. A reduction in the severity of lung injury and the quantity of alveolar edema should result in earlier extubation and more ventilator free days, improved pulmonary oxygen uptake, and improved lung compliance.
Study design: phase II/III prospective, randomized double-blind, placebo controlled trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Albuterol Sulfate | Active Comparator |
| |
| Placebo | Placebo Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Albuterol Sulfate | Drug | Albuterol sulfate, USP, solution for inhalation will be diluted as follows:
A high-efficiency small volume jet nebulizer (SVN) powered at a flow of 8 liters/minute from a 50 psi wall oxygen flow meter will be used for continuous nebulization. The study drug will be given every 4 hours (plus or minus one hour) for ten days following randomization or until 24 hours after extubation, whichever occurs first. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Ventilator Free Days (VFD) | Ventilator-free days (VFDs) is defined as the number of days from randomization to Day 28 after achieving unassisted breathing for patients who maintained unassisted breathing for at least two consecutive calendar days. If a patient achieved unassisted breathing, subsequently required additional assisted breathing, and once again achieved unassisted breathing, we counted only the VFDs after beginning the final period of unassisted breathing. Patients who died before Day 28 were assigned zero VFDs. | Determined 28 days after a subject entered the study |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality Prior to Hospital Discharge With Unassisted Breathing to Day 60 | Success for this efficacy variable was defined as being alive on study day 60 or having been discharged alive off mechanical ventilation from the study hospital (or subsequent hospital) to the subject's original place of residence. Those subjects alive in hospital at day 60 were considered to have survived. | Determined 60 days after a subject entered the study |
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Inclusion Criteria:
Must meet the following three criteria within a 24-hour period:
No clinical evidence of left-sided cardiac failure to account for bilateral pulmonary infiltrates
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Michael A. Matthay, MD | University of California, San Francisco | Principal Investigator |
| Roy Brower, MD | Johns Hopkins University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of San Francisco-Fresno Medical Center | Fresno | California | United States | |||
| University of California, Davis Medical Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27440140 | Derived | Brown SM, Wilson E, Presson AP, Zhang C, Dinglas VD, Greene T, Hopkins RO, Needham DM; with the National Institutes of Health NHLBI ARDS Network. Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome. Thorax. 2017 Apr;72(4):311-317. doi: 10.1136/thoraxjnl-2016-208560. Epub 2016 Jul 20. | |
| 26138630 | Derived | Ambrus DB, Benjamin EJ, Bajwa EK, Hibbert KA, Walkey AJ. Risk factors and outcomes associated with new-onset atrial fibrillation during acute respiratory distress syndrome. J Crit Care. 2015 Oct;30(5):994-7. doi: 10.1016/j.jcrc.2015.06.003. Epub 2015 Jun 16. |
| Label | URL |
|---|---|
| NHLBI Acute Respiratory Distress Syndrome Network Website | View source |
| ID | Type | URL | Comment |
|---|---|---|---|
| ARDSNet-ALTA | Individual Participant Data Set | View IPD |
a deidentified database of the ALVEOLI study is available through BioLINCC
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The trial was conducted with a combined Phase II/III design to enroll 1000 patients with a safety review performed after 100 subjects were enrolled and interim analysis looks at 250, 500, and 700 subjects. The first subject was entered in August 2007 and the last subject in July of 2008 when the study was stopped for futility at 282 enrolled.
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| ID | Title | Description |
|---|---|---|
| FG000 | Albuterol Sulfate | Aerosolized albuterol sulfate (5.0 mg dissolved in saline) every 4 hours |
| FG001 | Placebo | Preservative-free 0.9% sterile sodium chloride every 4 hours |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Mini-Bronchoalveolar Lavage (BAL) | Procedure | The mini-BAL procedure involves blind specimen sampling from distal airspaces. Specimens are obtained with the Combicath (Plastimed) catheter. The procedure will be done on study days 0 and 3 |
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| Placebo | Drug | Placebo aerosol will consist of 3.0 ml of identical appearing sterile 0.9 % sodium chloride without preservative. A high-efficiency small volume jet nebulizer (SVN) powered at a flow of 8 liters/minute from a 50 psi wall oxygen flow meter will be used for continuous nebulization (e.g.: throughout the inspiratory and expiratory cycle). The study drug will be given every 4 hours (plus or minus one hour) for ten days following randomization or until 24 hours after extubation, whichever occurs first. |
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| Mortality Prior to Hospital Discharge With Unassisted Breathing to Day 90 | Success for this efficacy variable was defined as being alive on study day 90 or having been discharged alive off mechanical ventilation from the study hospital (or subsequent hospital) to the subject's original place of residence. Those participants who still remained in the hospital at 90 days after randomization were considered to have survived. | Determined 90 days after a subject entered the study |
| Number of ICU-free Days at 28 Days After Randomization | ICU (intensive care unit)-free days was defined as the number of days a subject was out of the ICU during study hospitalization from date of randomization up to study day 28. All incidences of ICU admission and discharge during the study hospitalization were captured. Any portion of a calendar day that a subject was in the ICU was counted as an ICU day. | Determined 28 days after a subject entered the study |
| Number of Organ Failure-free Days at Day 28 Following Randomization | Subjects were followed for development of organ failures from date of randomization to hospital discharge or study day 28, whichever was first. Organ failure was defined as present on any calendar day when the most abnormal vital signs or clinically available lab value met the definition of clinically significant organ failure according to the Brussels Organ Failure Table. Each day a patient was alive and free of a given clinically significant organ failure was scored as a failure-free day. The worst value for a calendar day was captured (lowest systolic BP, platelet count and highest creatinine and bilirubin values). Specific definitions of organ failure were: cardiovascular-systolic BP less than or equal to 90 mmHg or on a vasopressor; coagulation-platelet count less than or equal to 80 x 1000/mm3; Renal-creatinine less than or equal to 2.0 mg/dL; Hepatic-bilirubin less than or equal to 2.0 mg/dL. | Daily from baseline to study day 28 |
| Ventilator Free Days to Day 28 in the Subset of Participants With ARDS | Difference in the main outcome Ventilator Free Days to study day 28 was calculated for the subset of patients with ARDS (defined as a PaO2/FiO2 ratio of less than or equal to 200). P/F ratio is an index of the effectiveness of arterial oxygenation that corresponds to the ratio of partial pressure of arterial O2 to the fraction of inspired O2. VFD to Day 28 is defined as the number of days from the end of ventilation to day 28 in patients who maintained unassisted breathing for at least two consecutive calendar days. Patients who died before day 28 were assigned a VFD count of zero. If a patient returned to assisted breathing, subsequently required assisted breathing, and once again achieved unassisted breathing, only the VFDs after beginning the final period of unassisted breathing were counted. An increase in the number of VFDs was considered a positive result. | Determined 28 days after a subject entered the study |
| Hospital Mortality to Day 60 in the Subset of Participants With ARDS | Difference in the main outcome mortality to study day 60 was calculated for the subset of patients with ARDS (defined as a PaO2/FiO2 ratio of less than or equal to 200) prior to randomization. P/F ratio is an index of the effectiveness of arterial oxygenation that corresponds to the ratio of partial pressure of arterial O2 to the fraction of inspired O2. | Determined 60 days after a subject entered the study |
| Ventilator Free Days to Day 28 in the Subset of Patients With Baseline Shock | Difference in the main outcome Ventilator Free Days to study day 28 was calculated for the subset of patients who were in shock at the time of randomization. Shock was defined as mean arterial pressure<60 or the need for vasopressors (except dopamine <6 ug/kg/min). | Determined 28 days after a subject entered the study |
| Hospital Mortality up to Day 60 in Subjects With Baseline Shock | Difference in the main outcome hospital mortality to study day 60 was calculated for the subset of patients who were in shock at the time of randomization. Shock was defined as mean arterial pressure<60 or the need for vasopressors (except dopamine <6 ug/kg/min). | Determined 60 days after a subject entered the study |
| Plasma Levels of IL-6 and IL-8 on Study Day 3 | Biologic end-points were selected that would provide mechanistic insight into how albuterol improved lung function. Concentrations of two proinflammatory cytokines, interleukin 6 and 8 (IL-6 and IL-8), were measured. Plasma was collected and cytokine levels were measured at baseline and 3 days after randomization. IL-6 and IL-8 levels were normalized using log transformation. Wilcoxon's test was used to compare mean log-transformed interleukin levels per day and a mixed-effects model was fit to compare the slopes. | Measured at baseline and 3 days after randomization |
| Sacramento |
| California |
| United States |
| UCSF-Moffitt Hospital | San Francisco | California | United States |
| UCSF-San Francisco General Hospital | San Francisco | California | United States |
| Centura St. Anthony Central Hospital | Denver | Colorado | United States |
| Denver Health Medical Center | Denver | Colorado | United States |
| Rose Medical Center | Denver | Colorado | United States |
| University of Colorado Health Sciences Center | Denver | Colorado | United States |
| Washington Hospital Center | Washington D.C. | District of Columbia | United States |
| Baton Rouge General Hospital-Blue Bonnet | Baton Rouge | Louisiana | United States |
| Baton Rouge General Hospital-Midcity | Baton Rouge | Louisiana | United States |
| Earl K. Long Medical Center | Baton Rouge | Louisiana | United States |
| Our Lady of the Lake Regional Medical Center | Baton Rouge | Louisiana | United States |
| Medical Center of Louisiana | New Orleans | Louisiana | United States |
| Ochsner Clinic Foundation | New Orleans | Louisiana | United States |
| Tulane University Health Sciences Center | New Orleans | Louisiana | United States |
| Baltimore VA Medical Center | Baltimore | Maryland | United States |
| Johns Hopkins Bayview Medical Center | Baltimore | Maryland | United States |
| Johns Hopkins Hospital | Baltimore | Maryland | United States |
| University of Maryland Shock Trauma Center | Baltimore | Maryland | United States |
| Baystate Medical Center | Springfield | Massachusetts | United States |
| Rochester Methodist Hospital | Rochester | Minnesota | United States |
| St. Mary's Hospital, Mayo Clinic | Rochester | Minnesota | United States |
| University of North Carolina | Chapel Hill | North Carolina | United States |
| Duke University Medical Center | Durham | North Carolina | United States |
| Durham Regional Medical Center | Durham | North Carolina | United States |
| Moses Cone Health System | Greensboro | North Carolina | United States |
| Wesley Long Community Hospital | Greensboro | North Carolina | United States |
| Wake Forest University Baptist Medical Center | Winston-Salem | North Carolina | United States |
| Cleveland Clinic Foundation | Cleveland | Ohio | United States |
| MetroHealth Medical Center | Cleveland | Ohio | United States |
| University Hospitals of Cleveland | Cleveland | Ohio | United States |
| Vanderbilt University Medical Center | Nashville | Tennessee | United States |
| Baylor College of Medicine | Houston | Texas | United States |
| McKay-Dee Hospital | Ogden | Utah | United States |
| Utah Valley Regional Medical Center | Provo | Utah | United States |
| LDS Hospital | Salt Lake City | Utah | United States |
| University of Virginia Medical Center | Charlottesville | Virginia | United States |
| Harborview Medical Center | Seattle | Washington | United States |
| University of Washington | Seattle | Washington | United States |
| 21562125 | Derived | National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, Holets S, Kallet RH, Liu KD, MacIntyre N, Moss M, Schoenfeld D, Steingrub J, Thompson BT. Randomized, placebo-controlled clinical trial of an aerosolized beta(2)-agonist for treatment of acute lung injury. Am J Respir Crit Care Med. 2011 Sep 1;184(5):561-8. doi: 10.1164/rccm.201012-2090OC. |
NHLBI provides controlled access to IPD through BioLINCC. Access requires registration, evidence of local IRB approval or certification of exemption from IRB review, and completion of a data use agreement. |
| Study Protocol | View IPD |
| Study Forms | View IPD |
| COMPLETED |
|
| NOT COMPLETED |
|
All randomized patients were analyzed.
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| ID | Title | Description |
|---|---|---|
| BG000 | Albuterol Sulfate | Aerosolized albuterol sulfate (5.0 mg dissolved in saline) every 4 hours |
| BG001 | Placebo | Preservative-free 0.9% sterile sodium chloride every 4 hours |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Standard Deviation | years |
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| Gender | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Ventilator Free Days (VFD) | Ventilator-free days (VFDs) is defined as the number of days from randomization to Day 28 after achieving unassisted breathing for patients who maintained unassisted breathing for at least two consecutive calendar days. If a patient achieved unassisted breathing, subsequently required additional assisted breathing, and once again achieved unassisted breathing, we counted only the VFDs after beginning the final period of unassisted breathing. Patients who died before Day 28 were assigned zero VFDs. | All the intent to treat patients were analyzed. Data was available on all subjects for the primary analysis only. | Posted | Mean | Standard Error | days | Determined 28 days after a subject entered the study |
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| Secondary | Mortality Prior to Hospital Discharge With Unassisted Breathing to Day 60 | Success for this efficacy variable was defined as being alive on study day 60 or having been discharged alive off mechanical ventilation from the study hospital (or subsequent hospital) to the subject's original place of residence. Those subjects alive in hospital at day 60 were considered to have survived. | Intent to treat population. | Posted | Number | percentage of participants who died | Determined 60 days after a subject entered the study |
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| Secondary | Mortality Prior to Hospital Discharge With Unassisted Breathing to Day 90 | Success for this efficacy variable was defined as being alive on study day 90 or having been discharged alive off mechanical ventilation from the study hospital (or subsequent hospital) to the subject's original place of residence. Those participants who still remained in the hospital at 90 days after randomization were considered to have survived. | Intent to treat. | Posted | Number | percentage of participants who died | Determined 90 days after a subject entered the study |
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| Secondary | Number of ICU-free Days at 28 Days After Randomization | ICU (intensive care unit)-free days was defined as the number of days a subject was out of the ICU during study hospitalization from date of randomization up to study day 28. All incidences of ICU admission and discharge during the study hospitalization were captured. Any portion of a calendar day that a subject was in the ICU was counted as an ICU day. | Intent to treat. | Posted | Mean | Standard Error | days | Determined 28 days after a subject entered the study |
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| Secondary | Number of Organ Failure-free Days at Day 28 Following Randomization | Subjects were followed for development of organ failures from date of randomization to hospital discharge or study day 28, whichever was first. Organ failure was defined as present on any calendar day when the most abnormal vital signs or clinically available lab value met the definition of clinically significant organ failure according to the Brussels Organ Failure Table. Each day a patient was alive and free of a given clinically significant organ failure was scored as a failure-free day. The worst value for a calendar day was captured (lowest systolic BP, platelet count and highest creatinine and bilirubin values). Specific definitions of organ failure were: cardiovascular-systolic BP less than or equal to 90 mmHg or on a vasopressor; coagulation-platelet count less than or equal to 80 x 1000/mm3; Renal-creatinine less than or equal to 2.0 mg/dL; Hepatic-bilirubin less than or equal to 2.0 mg/dL. | Intent to treat. | Posted | Mean | Standard Error | days | Daily from baseline to study day 28 |
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| Secondary | Ventilator Free Days to Day 28 in the Subset of Participants With ARDS | Difference in the main outcome Ventilator Free Days to study day 28 was calculated for the subset of patients with ARDS (defined as a PaO2/FiO2 ratio of less than or equal to 200). P/F ratio is an index of the effectiveness of arterial oxygenation that corresponds to the ratio of partial pressure of arterial O2 to the fraction of inspired O2. VFD to Day 28 is defined as the number of days from the end of ventilation to day 28 in patients who maintained unassisted breathing for at least two consecutive calendar days. Patients who died before day 28 were assigned a VFD count of zero. If a patient returned to assisted breathing, subsequently required assisted breathing, and once again achieved unassisted breathing, only the VFDs after beginning the final period of unassisted breathing were counted. An increase in the number of VFDs was considered a positive result. | Patients meeting the criteria for ARDS (pre-randomization PaO2/FiO2 ratio less than or equal to 200) were selected for this subset. | Posted | Mean | Standard Error | days | Determined 28 days after a subject entered the study |
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| Secondary | Hospital Mortality to Day 60 in the Subset of Participants With ARDS | Difference in the main outcome mortality to study day 60 was calculated for the subset of patients with ARDS (defined as a PaO2/FiO2 ratio of less than or equal to 200) prior to randomization. P/F ratio is an index of the effectiveness of arterial oxygenation that corresponds to the ratio of partial pressure of arterial O2 to the fraction of inspired O2. | Patients meeting the criteria for ARDS (pre-randomization PaO2/FiO2 ratio less than or equal to 200) were selected for this subset. | Posted | Number | percentage of participants who died | Determined 60 days after a subject entered the study |
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| Secondary | Ventilator Free Days to Day 28 in the Subset of Patients With Baseline Shock | Difference in the main outcome Ventilator Free Days to study day 28 was calculated for the subset of patients who were in shock at the time of randomization. Shock was defined as mean arterial pressure<60 or the need for vasopressors (except dopamine <6 ug/kg/min). | Patients with protocol defined shock (mean arterial pressure<60 or need for vasopressors except dopamine < 6ug/kg/min) at the time of study entry. | Posted | Mean | Standard Error | days | Determined 28 days after a subject entered the study |
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| Secondary | Hospital Mortality up to Day 60 in Subjects With Baseline Shock | Difference in the main outcome hospital mortality to study day 60 was calculated for the subset of patients who were in shock at the time of randomization. Shock was defined as mean arterial pressure<60 or the need for vasopressors (except dopamine <6 ug/kg/min). | Patients with protocol defined shock (mean arterial pressure<60 or need for vasopressors except dopamine < 6ug/kg/min) at the time of study entry. | Posted | Number | percentage of participants who died | Determined 60 days after a subject entered the study |
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| Secondary | Plasma Levels of IL-6 and IL-8 on Study Day 3 | Biologic end-points were selected that would provide mechanistic insight into how albuterol improved lung function. Concentrations of two proinflammatory cytokines, interleukin 6 and 8 (IL-6 and IL-8), were measured. Plasma was collected and cytokine levels were measured at baseline and 3 days after randomization. IL-6 and IL-8 levels were normalized using log transformation. Wilcoxon's test was used to compare mean log-transformed interleukin levels per day and a mixed-effects model was fit to compare the slopes. | Not all subjects had available data for secondary analyses and therefor the numbers will be less than the 152 (active) and 130 (placebo) arms. | Posted | Log Mean | Standard Deviation | pg/ml | Measured at baseline and 3 days after randomization |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Albuterol Sulfate | Aerosolized albuterol sulfate (5.0 mg dissolved in saline) every 4 hours | 1 | 152 | 21 | 152 | ||
| EG001 | Placebo | Preservative-free 0.9% sterile sodium chloride every 4 hours | 1 | 130 | 15 | 130 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hypoxemia | Respiratory, thoracic and mediastinal disorders | COSTART 5.0 | Systematic Assessment |
| |
| Hypoxia | Respiratory, thoracic and mediastinal disorders | COSTART 5.0 | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Arrhythmias (clinically important) | Cardiac disorders | COSTART 5.0 | Systematic Assessment |
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| Hypokalemia | Metabolism and nutrition disorders | COSTART 5.0 | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| David Schoenfeld, ARDSNet CCC PI | Acute Respiratory Distress Syndrome (ARDS) Network | 617-726-6111 | dschoenfeld@partners.org |
| ID | Term |
|---|---|
| D012128 | Respiratory Distress Syndrome |
| D055371 | Acute Lung Injury |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D012120 | Respiration Disorders |
| D055370 | Lung Injury |
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| ID | Term |
|---|---|
| D000420 | Albuterol |
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
| D000588 | Amines |
| D010627 | Phenethylamines |
| D005021 | Ethylamines |
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
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| >=65 years |
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| Male |
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