Continuous intravenous terbutaline for pediatric status asthmaticus

OBJECTIVESTo 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. DESIGNA retrospective review of children admitted with status asthmaticus who failed emergency room therapy and required intravenous terbutaline. SETTINGSan Diego Children's Hospital Pediatric Intensive Care Unit. PATIENTSEighteen children with status asthmaticus, based on clinical and laboratory criteria, between September 1994 and July 1996. INTERVENTIONSEpinephrine was added for below-normal decreases in diastolic blood pressure. MEASUREMENTS AND MAIN RESULTSContinuous 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. CONCLUSIONSIntravenous terbutaline was well tolerated in asthmatic children for 2 [micro sign]g/kg/min. There was no mortality. (Crit Care Med 1998; 26:1744-1748)