Early administration of terbutaline in severe pediatric asthma may reduce incidence of acute respiratory failure

Publication Date

2014

Journal Title

Ann Allergy Asthma Immunol

Abstract

BACKGROUND: Severe pediatric asthma, if not immediately and aggressively treated, may progress to acute respiratory failure requiring mechanical ventilation in the pediatric intensive care unit (PICU). Intravenous (IV) terbutaline, a beta2 agonist, is dispensed when the initial treatment does not improve the clinical condition. OBJECTIVE: To investigate the influence of early initiation of IV terbutaline on the incidence of acute respiratory failure requiring mechanical ventilation in severe pediatric asthma. METHODS: A retrospective chart review was conducted of 120 subjects (35 patients from an outside hospital emergency department [ED] with late start of terbutaline and 85 patients from the authors' hospital ED with early initiation of IV terbutaline) admitted to the PICU with severe asthma treated with continuous IV terbutaline. Responses to terbutaline treatment and outcomes were evaluated. RESULTS: Patients transported from outlying hospital EDs had shorter pre-PICU mean durations of IV terbutaline than those transferred from the authors' ED (0.69 +/- 1.38 and 2.91 +/- 2.47 hours, respectively, P = .001). Twenty-one of 35 patients (60%) from outlying EDs required mechanical ventilation compared with 14 of 85 patients (16%) from the authors' ED (P = .001). Durations of pre-PICU terbutaline infusion for patients requiring mechanical ventilation were significantly shorter than those with no such requirement (P = .015). CONCLUSION: The results of the present study, conducted in the largest number of subjects to date, suggest that early administration of continuous terbutaline in the ED may decrease acute respiratory failure and the need for mechanical respiratory (invasive and noninvasive) support in severe pediatric asthma.

Volume Number

112

Issue Number

3

Pages

207-10

Document Type

Article

EPub Date

2014/01/29

Status

Faculty, Northwell Researcher

Facility

School of Medicine; Northwell Health

Primary Department

General Pediatrics

PMID

24468309

DOI

10.1016/j.anai.2014.01.003

For the public and Northwell Health campuses

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