title: Diastolic Hypotension, Troponin Elevation, and Electrocardiographic Changes Associated With the Management of Moderate to Severe Asthma in Children.
abstract: The objective was to determine the occurrence of, and the factors associated with, diastolic hypotension and troponin elevation or electrocardiogram (ECG) ST-segment changes in a convenience sample of children with moderate to severe asthma receiving continuous albuterol nebulization.
  
  
  
  This was a prospective, descriptive study in a pediatric emergency department and an intensive care unit of a tertiary academic center. Fifty children with moderate to severe asthma (clinical asthma score > 8) who received 10 to 15 mg/hour continuous albuterol for >2 hours between June 5, 2007, and February 4, 2008, were approached. Hourly diastolic blood pressures were recorded. Cardiac troponin I (cTnI) and ECG tracings were obtained following the first 2 hours of albuterol and then subsequently every 12 hours while receiving continuous albuterol. Main outcome measures were: 1) incidence of diastolic hypotension, 2) incidence of troponin elevation, and 3) incidence of ECG ST-depression.
  
  
  
  Fifty patients were enrolled. Thirty-three (66%) patients developed diastolic hypotension during the first 6 hours of continuous albuterol. Diastolic blood pressure declined from baseline at 1-6 hours (p < 0.01 vs. baseline). Twelve patients (24%) had elevated cTnI, 15 patients (30%) had ST-segment change, four patients (8%) had both, and 23 patients (46%, 95% confidence interval [CI] = 32 to 60) had either a cTnI elevation or an ECG ST-segment change. Troponin elevation and diastolic hypotension were not associated (RR = 1.2, 95% CI = 0.6 to 2.3).
  
  
  
  In a subset of children with moderate to severe asthma, diastolic hypotension, troponin elevation, and ECG ST-segment change occur during administration of continuous albuterol. Future studies are necessary to determine the clinical significance of these findings.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fagbuyi
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Venkataraman
authors.affiliation: Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: J Carter
authors.initials: JC
authors.lastname: Ralphe
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Zuckerbraun
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Pitetti
authors.affiliation: Institute for Clinical Research Education, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Kwonho
authors.initials: K
authors.lastname: Jeong
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Saladino
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Mioara D
authors.initials: MD
authors.lastname: Manole
mesh_terms: D000420:Albuterol / Q000008:administration & dosage; D062186:Arterial Pressure; D001249:Asthma / Q000188:drug therapy* / Q000473:pathology*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis*; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood*
chemical_list: D001993:Bronchodilator Agents; D019210:Troponin I; D000420:Albuterol