title: Protocol-based titration of intravenous terbutaline decreases length of stay in pediatric status asthmaticus.
abstract: Although frequently used to treat status asthmaticus in children, intravenous (IV) terbutaline has not been shown to decrease hospital length of stay (LOS). We theorized that this lack of demonstrable benefit resulted from variations in dosing and titration, rather than the drug per se, and that intensive care unit (ICU) LOS would be shortened by the administration of terbutaline according to a protocol incorporating a quantitative assessment of severity of illness. We prospectively treated 20 consecutive children with status asthmaticus with IV terbutaline according to a protocol that titrated the dose based on a clinical asthma score, the Modified Pulmonary Index Score (MPIS). Data were compared to a historic cohort of the previous 20 consecutive ICU patients with status asthmaticus who were treated with IV terbutaline prior to initiation of the protocol. Patients who received terbutaline by standardized protocol had significantly shorter ICU LOS (3.5 +/- 1.1 vs. 5.0 +/- 2.0 days, P = 0.01), shorter hospital LOS (5.5 +/- 1.3 vs. 8.3 +/- 2.7 days, P < 0.01), and reduced hospital charges ($19,298 +/- $10,516 vs. $26,528 +/- $12,328, P = 0.04). The method of administration of IV terbutaline significantly influenced ICU length of stay and hospital charges.
authors.affiliation: Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA. ccarrol@ccmckids.org
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.forename: Craig M
authors.initials: CM
authors.lastname: Schramm
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000420:Albuterol / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002985:Clinical Protocols; D003237:Connecticut; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012720:Severity of Illness Index; D013726:Terbutaline / Q000627:therapeutic use*
chemical_list: D000318:Adrenergic beta-Agonists; D013726:Terbutaline; D000420:Albuterol