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Continuous intravenous terbutaline for pediatric status asthmaticus

Stephanopoulos, Dimitrios E. MD, FAAP; Monge, Roberto MD; Schell, Kenneth H. PharmD; Wyckoff, Pamela PharmD; Peterson, Bradley M. MD, FCCM

Pediatric Critical Care

Objectives To determine the clinical effects of intravenous terbutaline at >0.4 [micro sign]g/kg/min in children with status asthmaticus; to describe the clinical findings associated with such therapy, including creatinine phosphokinase-myocardial band isoenzyme (CPK-MB) concentrations, electrocardiographic alterations, and decreased diastolic blood pressure (DBP) with terbutaline usage; and to assess the requirement for epinephrine to counteract the decrease in diastolic blood pressure.

Design A retrospective review of children admitted with status asthmaticus who failed emergency room therapy and required intravenous terbutaline.

Setting San Diego Children's Hospital Pediatric Intensive Care Unit.

Patients Eighteen children with status asthmaticus, based on clinical and laboratory criteria, between September 1994 and July 1996.

Interventions Epinephrine was added for below-normal decreases in diastolic blood pressure.

Measurements and Main Results Continuous monitoring for arrhythmias, ST-segment changes, and DBP values during variations in the dose of intravenous terbutaline, with or without epinephrine. CPK-MB concentrations were determined in 15 of 18 patients.

Conclusions Intravenous terbutaline was well tolerated in asthmatic children for <or=to305 continuous hours and at varying doses up to a maximum of 10 [micro sign]g/kg/min. There was no relationship between the magnitude of CPK-MB concentrations and the terbutaline or epinephrine doses used. Arrhythmias were rare and not related to either terbutaline or epinephrine doses. However, ST-segment depression did occur in two patients requiring high-dose epinephrine. Terbutaline significantly lowered DBP when used between 0.4 and 1.0 [micro sign]g/kg/min, which required epinephrine to be initiated. Epinephrine was not required at terbutaline doses of >2 [micro sign]g/kg/min. There was no mortality. (Crit Care Med 1998; 26:1744-1748)

From the Division of Critical Care Medicine, San Diego Children's Hospital, San Diego, CA.

Address requests for reprints to: Dimitrios E. Stephanopoulos, MD, Division of Critical Care Medicine, Department of Pediatrics, P.O. Box 19230, Southern Illinois University School of Medicine, Springfield, IL 62794-1614.

© Williams & Wilkins 1998. All Rights Reserved.