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ARrest RESpiraTory Failure From PNEUMONIA (ARREST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04193878
Recruitment Status : Enrolling by invitation
First Posted : December 10, 2019
Last Update Posted : March 19, 2021
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)
Information provided by (Responsible Party):
Jennifer Wilson, MD, Stanford University

Brief Summary:
This research study seeks to establish the effectiveness of a combination of an inhaled corticosteroid and a beta agonist compared to placebo for the prevention of acute respiratory failure (ARF) in hospitalized patients with pneumonia and hypoxemia.

Condition or disease Intervention/treatment Phase
Pneumonia Hypoxemia Acute Respiratory Failure Drug: Inhaled budesonide and formoterol Drug: Inhaled placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 600 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: ARrest RESpiraTory Failure From PNEUMONIA (ARREST PNEUMONIA)
Actual Study Start Date : June 1, 2020
Estimated Primary Completion Date : April 1, 2024
Estimated Study Completion Date : June 1, 2024

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Placebo Comparator: Placebo
4 ml aerosolized 0.9% saline every 12 hours x 10 doses
Drug: Inhaled placebo
aerosolized saline (4 ml of 0.9% saline) twice daily for up to 5 days
Other Name: aerosolized 0.9% saline

Active Comparator: Intervention
aerosolized formoterol (20 mcg/2 ml) and budesonide (1.0 mg/2 ml) every 12 hours x 10 doses
Drug: Inhaled budesonide and formoterol
aerosolized doses of budesonide (1.0 mg/2 ml) and formoterol (20 mg/2 ml) twice daily for up to 5 days
Other Name: Pulmicort Respules (budesonide) and Perforomist (formoterol)

Primary Outcome Measures :
  1. Acute respiratory failure (ARF) [ Time Frame: within 7 days of randomization ]
    High flow nasal cannula (HFNC) and/or Noninvasive ventilation (NIV) use for greater than 36 hours OR Invasive mechanical ventilation for greater than 36 hours OR Death in a patient placed on respiratory support (HFNC, NIV, ventilator) who dies before 36 hours

Secondary Outcome Measures :
  1. Hospital length of stay [ Time Frame: within 60 days of randomization ]
  2. Duration of need for supplemental oxygen [ Time Frame: within 60 days of randomization ]
  3. Proportion of patients intubated for respiratory failure [ Time Frame: Within 7 days of randomization ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Severe Pneumonia defined as hospitalization for acute (< 7 days) onset of symptoms (cough, sputum production, or dyspnea) and radiographic evidence of pneumonia by chest radiograph or CT scan and evidence of systemic inflammation (temperature < 35oC or > 38oC or WBC > or < upper or lower limits for site or procalcitonin > 0.5 mcg/L), or known current immunosuppression preventing inflammatory response.


  • Hypoxemia defined as new requirement for supplemental oxygen with SpO2 < 90% on room air, ≤ 96% on ≥ 2 L/min oxygen, or > 6L/min or NIV (regardless of SpO2) at enrollment.


  • No clinical suspicion for COVID-19 pneumonia or confirmed negative test for SARS CoV2 infection.

Exclusion Criteria:

  • Inability to obtain consent within 24 hours of presentation to emergency room
  • Intubation (or impending intubation) prior to enrollment (This does not include those patients receiving High flow nasal cannula (HFNC) oxygen or Noninvasive ventilation (NIV) prior to enrollment)
  • A condition requiring inhaled corticosteroids or beta-agonists, or chronic systemic steroid therapy equivalent to a dose >10 mg prednisone (this does not include patients receiving inhaled beta-agonists in the Emergency Department without an established indication if treating clinician is willing to discontinue subsequent treatments)
  • Chronic lung or neuromuscular disease requiring daytime oxygen or mechanical ventilation other than for obstructive sleep apnea (OSA) or obesity hypoventilation syndrome
  • Not anticipated to survive > 48 hours or not expected to require > 48 hours of hospitalization
  • Contraindication or known allergy to inhaled corticosteroids or beta-agonists
  • Patients with heart rate > 130 bpm, ventricular tachycardia or new supraventricular tachycardia within last 4 hours will be potentially eligible for enrollment after the condition has resolved
  • Patients with K+ < 3.0 will be potentially eligible for enrollment after the condition has resolved
  • Patient not committed to full support other than intubation or resuscitation (i.e., DNR/DNI status allowed)
  • Pregnancy
  • Incarcerated individual
  • Physician refusal of consent to protocol
  • Patient/surrogate refusal of consent to protocol

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04193878

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United States, Arizona
Mayo Clinic - Scottsdale
Scottsdale, Arizona, United States, 85259
University of Arizona
Tucson, Arizona, United States, 85724
United States, California
Stanford University
Palo Alto, California, United States, 94304
United States, Florida
University of Florida
Gainesville, Florida, United States, 32608
Mayo Clinic - Jacksonville
Jacksonville, Florida, United States, 32224
United States, Maryland
Johns Hopkins University
Baltimore, Maryland, United States, 21205
United States, Minnesota
Mayo Clinic - Rochester
Rochester, Minnesota, United States, 55905
United States, New York
New York University - Langone Health
New York, New York, United States, 10016
United States, Pennsylvania
Temple University
Philadelphia, Pennsylvania, United States, 19140
Sponsors and Collaborators
Stanford University
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health (NIH)
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Principal Investigator: Joe Levitt, MD Stanford University
Principal Investigator: Emir Festic, MD Mayo Clinic
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Jennifer Wilson, MD, Clinical Assistant Professor, Stanford University Identifier: NCT04193878    
Other Study ID Numbers: 53599
1UG3HL141722-01A1 ( U.S. NIH Grant/Contract )
First Posted: December 10, 2019    Key Record Dates
Last Update Posted: March 19, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Respiratory Insufficiency
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Respiration Disorders
Signs and Symptoms, Respiratory
Formoterol Fumarate
Anti-Inflammatory Agents
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Adrenergic beta-2 Receptor Agonists
Adrenergic beta-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action