title: Effects of nebulized bronchodilator therapy on heart rate and arrhythmias in critically ill adult patients.
abstract: BACKGROUND
  Tachycardia and tachyarrhythmias are associated with increased morbidity and mortality in adult patients in the ICU. This study examines the effects of nebulized bronchodilator therapy (albuterol and ipratropium) on heart rate and arrhythmias in this population and tests the proposition that levalbuterol is safer than albuterol in that regard.
  
  
  METHODS
  The design was a randomized, single-blind, crossover, prospective study in 70 critically ill adult patients treated with nebulized bronchodilators. Patients were randomized to nebulized albuterol alternating with levalbuterol every 4 to 6 h. Group A received albuterol 2.5 mg alternating with levalbuterol 0.63 mg. Group B received albuterol 2.5 mg alternating with levalbuterol 1.25 mg. All patients received nebulized ipratropium bromide with each treatment. Heart rate was recorded before and after each treatment. Cardiac rhythm was continuously monitored using electronic telemetry units.
  
  
  RESULTS
  In group A, mean ± SD change in heart rate after albuterol 2.5 mg (n = 303) was 0.89 ± 4.5 beats/min compared with 0.85 ± 5.3 beats/min after levalbuterol 0.63 mg (n = 301) (P = .89). In group B (n = 114), heart rate decreased 0.16 ± 5.1 beats/min after albuterol 2.5 mg compared with an increase of 1.4 ± 5.4 beats/min after levalbuterol 1.25 mg (n = 118) (P = .03). Five events of arrhythmias (0.6%) occurred during the course of 836 treatments. Four consisted of occasional premature ventricular contractions. Only one patient stopped treatment because of a 5-beat run of ventricular tachycardia (one in 70 patients [1.4%]).
  
  
  CONCLUSIONS
  In critically ill adult patients, nebulized albuterol and ipratropium does not cause significant tachycardia or tachyarrhythmias. Substitution of levalbuterol for albuterol to avoid tachycardia and tachyarrhythmias is unwarranted.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01151579; URL: www.clinicaltrials.gov.
authors.affiliation: Pulmonary and Critical Care Medicine Department, Genesys Regional Medical Center, Grand Blanc, MI; Michigan State University College of Human Medicine, East Lansing, MI.
authors.forename: Fahim M
authors.initials: FM
authors.lastname: Khorfan
authors.affiliation: Office of Research, Genesys Regional Medical Center, Grand Blanc, MI.
authors.forename: Patricia
authors.initials: P
authors.lastname: Smith
authors.affiliation: Office of Research, Genesys Regional Medical Center, Grand Blanc, MI.
authors.forename: Sandra
authors.initials: S
authors.lastname: Watt
authors.affiliation: Office of Research, Genesys Regional Medical Center, Grand Blanc, MI; Michigan State University College of Human Medicine, East Lansing, MI. Electronic address: kbarber@genesys.org.
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Barber
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units; D009241:Ipratropium / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol