Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia.
BACKGROUND
Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients.


METHODS
The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered.


RESULTS
Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement.


CONCLUSIONS
Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents.


METHODS
Therapeutic study, level IV.
From the Department of Surgery (C.H.E.), University of Nebraska Medical Center, Omaha, Nebraska; Division of Trauma & Emergency Surgery, Department of Surgery (C.R.S., C.S.C.), and Department of Pharmacy (J.J.D.), University of California, Davis Medical Center, Sacramento, California; and Department of Pharmacy (A.J.B.), Banner Good Samaritan Medical Center, Phoenix, Arizona.
Charity H
CH
Evans
Jeremiah J
JJ
Duby
Andrew J
AJ
Berry
Carol R
CR
Schermer
Christine S
CS
Cocanour
D000284:Administration, Oral; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage*; D001919:Bradycardia / Q000188:drug therapy* / Q000209:etiology*; D002574:Cervical Vertebrae / Q000293:injuries; D018678:Cholinergic Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014193:Trauma Centers; D016896:Treatment Outcome
D058666:Adrenergic beta-2 Receptor Agonists; D018678:Cholinergic Agents; D000420:Albuterol