A randomized trial of the effects of nebulized albuterol on pulmonary edema in brain-dead organ donors.
Ware LB, Landeck M, Koyama T, et al.Am J Transplant. 2014;14(3):621-8.
Aims
To investigate whether aerosolized beta-2 agonist (albuterol) improves donor oxygenation and static compliance by enhancing the clearance of pulmonary edema in brain dead organ donors. The study also included a subset of enrolled donors to investigate whether aerosolized albuterol would reduce pulmonary edema and enhance the rate of alveolar fluid clearance.
Interventions
The brain dead donors were administered with aerosolized albuterol or aerosolized placebo (saline).
Participants
591 brain dead lung donors >14 years.
Outcomes
The primary outcomes included change in arterial pressure of oxygen/fraction of inspired oxygen ratio from enrolment to organ procurement or to 72 hours. The secondary outcomes included the change in static compliance of the respiratory system and the change in chest radiographic score from enrolment to organ procurement and the donor lung utilisation rate.
Follow-up
1 year.
CET Conclusions
This large, well-designed, blinded trial investigates the use of a nebulised beta-2 agonist in potential DBD donors in an attempt to reduce pulmonary oedema and increase oxygen exchange and lung utilisation. The authors report no significant difference in the primary outcome (change in PaO2/FiO2) or in the utilisation or outcomes of the organs procured. This trial is interesting for two reasons. Firstly, it is a large trial with essentially negative results. It is therefore refreshing to see it published in a mainstream journal as negative findings of this magnitude are clearly very important. Secondly, it demonstrates the feasibility of large scale, ethically acceptable trials in donor management in an attempt to increase organ procurement rates. One note of caution: the results are not reported as intention-to-treat. 85 donors were excluded between the time of randomisation to analysis, and it is possible that the study drug may have affected the likelihood of donors to proceed to donation. Without full data on these withdrawals, the reader cannot ascertain if this is true.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov - NCT0031040