Furosemide as Supportive Therapy for Respiratory Failure secondary to Pulmonary Infection (FAST - 3).

Although the majority of patients who develop lung infections have mild illness some develop critical illness requiring the help of mechanical ventilators to help them breathe. The infections that can cause this include viruses (COVID-19, Influenza and RSV) and bacteria. When severe disease develops, it can cause death and health complications like prolonged hospitalization, organ failure and reduced quality of life. In addition to antibiotics and antivirals, there is a need for additional therapies to improve outcomes from severe respiratory infection. In lung infections, one of the causes of breathing problems is inflammation and there is no accepted treatment for this. In this trial, we are studying the effect of furosemide, a commonly used diuretic drug on lung inflammation caused by infection. Furosemide has been used for decades, is readily available, cheap and easy to manufacture. In addition to its diuretic effects, it has potent anti-inflammatory effects. Although furosemide is normally given by mouth or intravenously, we will give the furosemide by inhalation leading to a direct effect on the lungs thus avoiding effects on the rest of the body including its diuretic effects. We propose to enroll 1500 patients suffering from severe respiratory infections. One half of the patients will be randomized to a group which will receive best current care plus an inhaled salt solution as a placebo. The other group will receive best current care and inhaled furosemide. We will study the effect of the inhaled furosemide on the duration of respiratory support, death, lung function, need for oxygen, duration of ICU care and hospitalization. If improvement is found in the patients who receive inhaled furosemide, we will implement this treatment widely since it is a novel type of treatment, cheap and readily available thereby improving the outcomes of those who become ill at the present but also making us more ready for future pandemics.