Continuous intravenous terbutaline for pediatric status asthmaticus

Crit Care Med. 1998 Oct;26(10):1744-8. doi: 10.1097/00003246-199810000-00033.

Abstract

Objectives: To determine the clinical effects of intravenous terbutaline at >0.4 microg/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 =305 continuous hours and at varying doses up to a maximum of 10 microg/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 microg/kg/min, which required epinephrine to be initiated. Epinephrine was not required at terbutaline doses of >2 microg/kg/min. There was no mortality.

MeSH terms

  • Adolescent
  • Arrhythmias, Cardiac / chemically induced
  • Blood Pressure / drug effects
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Creatine Kinase / blood
  • Drug Monitoring
  • Drug Therapy, Combination
  • Electrocardiography
  • Epinephrine / therapeutic use
  • Female
  • Humans
  • Infusions, Intravenous / methods
  • Isoenzymes
  • Male
  • Retrospective Studies
  • Status Asthmaticus / drug therapy*
  • Status Asthmaticus / metabolism
  • Status Asthmaticus / physiopathology
  • Terbutaline / therapeutic use*
  • Time Factors

Substances

  • Bronchodilator Agents
  • Isoenzymes
  • Creatine Kinase
  • Terbutaline
  • Epinephrine