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Published on: December 17, 2017
Intravenous Salbutamol for Children With Severe Acute Asthma on a Dutch Pediatric Ward: An Effective and
I M Schellekens1, S Akhnikh2, M D Kruizinga2
1Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Intravenous salbutamol effectively treats severe acute asthma in children on pediatric wards, with 46% avoiding Pediatric Intensive Care Unit transfer. This approach demonstrates feasibility for managing pediatric severe acute asthma.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Intravenous (IV) salbutamol is a common treatment for severe acute asthma (SAA) in children.
- Traditionally, SAA requiring IV salbutamol necessitates Pediatric Intensive Care Unit (PICU) admission.
- Recent Dutch guidelines permit initiating IV salbutamol on medium care pediatric wards.
Purpose of the Study:
- To evaluate the efficacy and safety of treating children with SAA using IV salbutamol on Dutch pediatric wards.
- To determine the rate of successful treatment without PICU transfer.
- To assess adverse events and complications associated with IV salbutamol in this setting.
Main Methods:
- Retrospective multicenter cohort study.
- Inclusion of children with SAA treated with IV salbutamol from June 2021 to December 2023.
- Primary outcome: successful treatment without PICU transfer; Secondary outcomes: side effects and complications.
Main Results:
- 103 patients (112 exacerbations) were analyzed.
- 46% of children were successfully treated on the pediatric ward without PICU transfer.
- 61% experienced adverse events; three serious adverse events occurred, with no intubations or deaths.
Conclusions:
- IV salbutamol can be effectively administered to children with SAA on Dutch pediatric wards with medium care facilities.
- Nearly half of the children (46%) avoided PICU admission, indicating successful management on lower care levels.
- The study supports the feasibility of this treatment approach, with manageable adverse events.
Background:
Administration of intravenous (IV) salbutamol is a widely used intervention for managing severe acute asthma (SAA) in children, although evidence is limited. Traditionally, IV salbutamol is an indication for admission to a Pediatric Intensive Care Unit (PICU), however, recent Dutch guidelines allow this treatment to be initiated on a medium care pediatric ward. This study evaluated the efficacy of IV salbutamol treatment for children with SAA on two pediatric wards in the Netherlands.
Methods:
In this retrospective multicenter cohort study, we included children with SAA who have been treated with IV salbutamol between June 2021 and December 2023. The primary outcome was the number of children successfully treated with IV salbutamol without being transferred to a PICU. Secondary outcomes included severity of side effects and complications.
Results:
A total of 103 patients with 112 severe asthma exacerbations were included. Among these children, 46% were successfully treated on the pediatric ward. The remainder were transferred to a PICU, primarily due to exceeding the maximum allowed dose by protocol (1.0-1.5 mcg/kg/min) without an adequate response. Adverse events (e.g. hypokalemia, hyperglycemia, lactic acidosis, and hypotension) were observed in 61% of the children. Three serious adverse events were observed, no children were intubated nor were there any deaths.
Conclusion:
Children with SAA can be treated effectively with IV salbutamol on a Dutch pediatric ward with medium care facilities, since 46% of the children did not require a transfer to the PICU.
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