Continuous β-agonist therapy, typically in the form of inhaled albuterol, is common for the treatment of acute bronchospasm in children. Although this treatment is thought to carry minimal risk, concerns about potential cardiotoxicity have been raised. The purpose of this pilot study was to determine the cardiotoxic effects of continuous β-agonist therapy in children.
We conducted a retrospective review of all children admitted to the ICU between May 2008 and April 2009 who were treated with continuous β-agonist therapy (20–30 mg/hour) and had repeated serum troponin-T and lactate levels measured.
Twenty of the 36 children treated with continuous albuterol had repeated serum troponin and lactate levels measured every 12–24 hours. Eleven patients (55%) were also treated with continuous intravenous terbutaline. The mean age was 8.8 ± 5.0 years, the mean hospital length of stay (LOS) was 7.3 ± 4.4 days, and the mean ICU LOS was 4.5 ± 3.2 days. Elevated troponin-T levels were found in 25% of children (maximum values range: 0.03–0.3 ng/ml). However, all returned to normal levels within 48 hours of ICU admission, despite continued high-dose β-agonist therapy. None of these children experienced any arrhythmias while receiving continuous cardiac monitoring in the ICU. Elevated lactate levels were found in 60% of the children (maximum values range: 2.6–7.5 mmol/L), and all also normalized within 48 hours of ICU admission. There was no association between intravenous terbutaline use and elevated troponin (OR 1.3, 95% CI 0.2–10.3) or elevated serum lactate (OR 0.6, 95% CI 0.1–3.7). There was also no association between elevated troponin-T or lactate and ICU or hospital LOS.
In this pilot study, a significant proportion of children had elevated serum troponin-T and lactate levels while receiving inhaled continuous β-agonist therapy, irrespective of intravenous β-agonist use. However, these abnormal lab values were transient in this small population, all returning to normal levels within 48 hours of ICU admission.
Transient cardiotoxic effects of continuous albuterol should be considered in children.
Christopher Carroll, No Financial Disclosure Information; No Product/Research Disclosure Information