Continuous intravenous terbutaline for pediatric status asthmaticus

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology
• Emergency Medicine

Background:

• Status asthmaticus in children can be a life-threatening condition requiring intensive management.
• Intravenous beta-agonists, like terbutaline, are used in severe asthma exacerbations.
• Understanding the safety and efficacy of high-dose intravenous terbutaline is crucial for pediatric critical care.

Purpose of the Study:

• To evaluate the clinical effects of high-dose intravenous terbutaline (>0.4 microg/kg/min) in pediatric patients with status asthmaticus.
• To identify clinical findings, including cardiac effects and blood pressure changes, associated with this therapy.
• To assess the need for epinephrine to manage adverse effects like decreased diastolic blood pressure.

Main Methods:

• Retrospective review of 18 pediatric patients with status asthmaticus treated with intravenous terbutaline.
• Continuous monitoring of electrocardiograms (ECGs) and diastolic blood pressure (DBP).
• Creatinine phosphokinase-myocardial band isoenzyme (CPK-MB) levels measured in most patients; epinephrine administered for low DBP.

Main Results:

• Intravenous terbutaline was well-tolerated for up to 305 hours at doses up to 10 microg/kg/min.
• No correlation found between CPK-MB levels and terbutaline or epinephrine doses.
• Arrhythmias were rare; ST-segment depression occurred in two patients receiving high-dose epinephrine.

Conclusions:

• High-dose intravenous terbutaline is safe and effective for pediatric status asthmaticus.
• Terbutaline can cause significant diastolic blood pressure reduction at doses between 0.4-1.0 microg/kg/min, necessitating epinephrine.
• Epinephrine was not required at terbutaline doses exceeding 2 microg/kg/min; no mortality was observed.