Tachycardia and tachyarrhythmias are associated with increased morbidity and mortality in adult intensive care unit patients. This study examines the effects of nebulized bronchodilator therapy (albuterol and ipratropium) on heart rate and arrhythmias in this population with acute air flow obstruction and tests the proposition that levalbuterol has less effect on heart rate and arrhythmias than albuterol.
A randomized, single-blind, cross-over, prospective study was conducted in seventy critically ill adult patients with acute air flow obstruction. Patients were randomized to nebulized albuterol alternating with levalbuterol every 4 to 6 hours. Group A received albuterol 2.5 mg alternating with levalbuterol 0.63 mg. Group B received levalbuterol 0.63 mg alternating with albuterol 2.5 mg. Group C received levalbuterol 1.25 mg alternating with albuterol 2.5 mg. All patients received nebulized ipratropium bromide 500 micrograms with each treatment. Heart rate and cardiac rhythm were continuously recorded before and 15 minutes after finishing each treatment. Any new rhythm abnormalities between treatments were also recorded.
In 878 treatments, the mean change in heart rate was 0.7 per minute (SD 5.1). Change in heart rate post albuterol was 0.88 (P 0.01) group A, 0.90 (P 0.02) group B, 0.16 (P 0.74) group C, and post levalbuterol 0.63 mg it was 1.4 (P 0.004) group A, 0.44 (P0.27) group B. Post levalbuterol 1.25 mg in group C, heart rate increased 1.3 (P 0.01). Seven new arrhythmias (0.8%) occurred during this study of 878 treatments, three among albuterol and four among levalbuterol 0.63mg treatments. Six events were transient atrial and ventricular ectopics while one was paroxysmal atrial fibrillation. The difference in these numbers was not statistically significant (P 0.75).
In critically ill adult patients, the use of nebulized albuterol and ipratropium for airflow obstruction does not cause significant tachycardia and tachyarrhythmias. The substitution of levalbuterol for albuterol to avoid tachycardia and tachyarrhythmias is not warranted.
Using nebulized albuterol and ipratropium in critically ill adult patients is not associated with clinically significant tachycardia or tachyarrhythmias.
Kimberly Barber, No Financial Disclosure Information; No Product/Research Disclosure Information