Aims & Objectives:
The aim of this project was to review the current use of IV salbutamol for patients referred to the North West and North Wales Transfer Service (NWTS), for advice or transfer.
100 patients referred to NWTS with acute severe asthma requiring IV salbutamol were identified on the NWTS database. Data collection was retrospective from referral and transfer notes. Patients under 10kg were excluded.
100 patients received IV salbutamol in a dose of 1-5mcg/kg/min, total dose ranging from 0-380mcg/min, with 89 patients receiving a higher dose than the adult maximum of 20mcg/min. Median age was 7 years and median weight 23.7kg.
As the infusion dose for children was often notably higher than the maximum adult infusion of 20mcg/min, side effects were also studied.
The median heart rate was 170bpm. Maximum heart rate was 200bpm, lowest was 90bpm. The majority of patients had a heart rate above 150 regardless of infusion dose.
Median lactate was 4.5mmol/L. Ranging from 1.1–13.5mmol/L.
The majority of patients had a lactate within the region 2-6mmol/L, significantly higher than normal range (lactate <2mmol/L).
The presence or absence of nausea or vomiting was not regularly documented. 18% of patients were noted to have nausea or vomiting but it is unclear whether the other 82% had any symptoms.
Whilst the maximum adult dose of IV salbutamol is up to 20mcg/min, we found a wide range of dosing in our region. Future plans include review of the acute severe asthma guideline.