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Safety of continuous nebulized albuterol for bronchospasm in infants and children
R W Katz1, H W Kelly, M R Crowley
1Department of Pediatrics, School of Pharmacy, University of New Mexico, Albuquerque.
Objective:
To determine the incidence of cardiotoxicity in infants and children who receive continuous nebulized albuterol (CNA) for bronchospasm.
Design:
Prospective, case series.
Setting:
A university pediatric intensive care and pediatric subacute units.
Patients:
Nineteen infants and children who received CNA for at least 24 hours.
Interventions:
None.
Measurements:
Creatinine phosphokinase (CK) was measured at the time of admission and then at 12, 24, 48, and 72 hours while the patient received CNA. Isoenzyme CK-MB fractions were measured if CK concentration was > or = 250 IU/L. One electrocardiogram was obtained for each patient during CNA treatment. All patients had continuous cardiac monitoring during continuous nebulization therapy.
Main Results:
Creatinine phosphokinase levels remained within normal limits for 16 patients during CNA treatment. Three patients had elevated CK and in two CK-MB fractions were elevated at one measurement. None of the electrocardiograms showed evidence of ischemia and no arrhythmias were noted during CNA therapy, even in the patients with elevated CK-MB fractions.
Conclusions:
Continuous albuterol therapy appears to be safe in our patient population as there was no significant evidence of cardiotoxicity. The significance of the transient elevation of CK-MB without other evidence of cardiotoxicity remains to be determined.