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Optimizing pediatric esmolol dosing using computerized practitioner order entry

Tihua Chao1, James C Perry2, Gale L Romanowski1

  • 1Rady Children's Hospital, San Diego, California.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|March 13, 2015
PubMed

Insights

This study found that while esmolol is safe for pediatric patients, adherence to the institutional protocol was poor, leading to suboptimal dosing. A revised, data-driven protocol was implemented to improve therapeutic outcomes for cardiovascular conditions.

Area of Science:

  • Pediatric critical care pharmacology
  • Cardiovascular pharmacotherapy
  • Quality improvement initiatives

Background:

  • Esmolol is a beta-blocker used for blood pressure and rhythm control in pediatric patients.
  • Existing institutional guidelines for esmolol use require assessment for adherence, efficacy, and achievement of therapeutic targets.
  • Tachyarrhythmias and systemic hypertension are common critical conditions in pediatric intensive care.

Purpose of the Study:

  • To describe the cardiovascular dose-response and adverse effects of esmolol in pediatric patients.
  • To evaluate an institutional guideline's adherence, efficacy, and target achievement for pediatric tachyarrhythmias or hypertension.
  • To revise the esmolol dosing protocol based on study findings.

Main Methods:

  • Prospective study of pediatric/neonatal subjects receiving esmolol for blood pressure or rhythm control.
  • Inclusion criteria: intensive care unit (ICU) setting and bedside telemetry monitoring.
  • Data collected: demographics, esmolol administration, concurrent medications, cardiovascular goals, and vital signs.

Main Results:

  • Eight subjects (10 esmolol administrations) were included.
  • Esmolol demonstrated overall safety and effectiveness in controlling hypertension and tachyarrhythmia.
  • Poor protocol adherence resulted in subtherapeutic dosing, premature dose adjustments, and erratic dosing strategies.

Conclusions:

  • A new, data-driven protocol was developed and implemented following a program-wide conference.
  • The revised protocol offers more precise dosing and clearer therapeutic targets, considering esmolol pharmacokinetics.
  • This quality improvement initiative highlights the importance of evidence-based protocols in pediatric intensive care pharmacology.
Abstract

Keywords:
computerized practitioner order entryesmololpediatricspharmacologyquality improvement

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