SESSION TITLE: Pediatic Pulmonary & Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM
PURPOSE: Status asthmaticus is a common reason for pediatric intensive care unit (PICU) admission. Continuous nebulized albuterol is commonly used in these patients, but limited data exist to support a specific albuterol dose in critically ill children with status asthmaticus. Overall status asthmaticus care is protocolized in our PICU, but dosage of continuous albuterol is left to the discretion of the treating physician. The purpose of this study was to compare the toxicities and need for adjunctive therapies between 2 continuous albuterol doses used in our institution (10 mg/hr [low dose] vs 25 mg/hr [high dose]). Our hypothesis was that low dose continuous albuterol would be associated with lower toxicity without resulting in increased need for adjunctive therapies.
METHODS: We conducted a restrospective cohort study of all children receiving continuous nebulized albuterol in our tertiary-care PICU from 2011-2013. Our standard initial therapy for all patients was IV steroids, inhaled ipratropium, and continuous nebulized albuterol. Patients receiving 10 mg/hr albuterol were compared to those receiving 25 mg/hr albuterol; patients receiving both doses during their PICU stay were excluded from analysis. In addition to baseline patient characteristics, need for adjunctive therapies for asthma as well as hypotension requiring fluid bolus resuscitation were compared.
RESULTS: We compared 693 low-dose albuterol patients to 432 high-dose albuterol patients. Patients receiving low-dose albuterol had a lower need for IV fluid bolus resuscitation (71% vs 84%; p<0.0001). Low-dose albuterol patients were more likely to be treated with noninvasive positive pressure support (67% vs 59%; p= 0.0129) and IV magnesium (69% vs 61 %; p=0.0036). While no significant difference was seen in ICU LOS, patients receiving low-dose albuterol did have lower hospital LOS (3.6 vs 3.9 days; p=0.0172).
CONCLUSIONS: In our cohort of critically ill children with status asthmaticus, 10 mg/hr continuous albuterol was associated with decreased fluid bolus need and length of stay. It was associated with increased use of adjunctive therapies although this may be related to local changes in asthma care over time. Further prospective studies are needed to identify the optimal dose of continuous albuterol for PICU care of status asthmaticus.
CLINICAL IMPLICATIONS: These results support the consideration of lower dose continuous albuterol in critically ill children with status asthmaticus to reduce side effects without jeopardizing patient outcomes.
DISCLOSURE: The following authors have nothing to disclose: Ada Lin, Todd Karsies
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