Continuous intravenous terbutaline for pediatric status asthmaticus.
OBJECTIVE
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.


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


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


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


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


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.
Division of Critical Care Medicine, San Diego Children's Hospital, CA, USA.
D E
DE
Stephanopoulos
R
R
Monge
K H
KH
Schell
P
P
Wyckoff
B M
BM
Peterson
D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001794:Blood Pressure / Q000187:drug effects; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007527:Isoenzymes; D008297:Male; D012189:Retrospective Studies; D013224:Status Asthmaticus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D013726:Terbutaline / Q000627:therapeutic use*; D013997:Time Factors
D001993:Bronchodilator Agents; D007527:Isoenzymes; D003402:Creatine Kinase; D013726:Terbutaline; D004837:Epinephrine