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Jim -



In our system we are currently using 7.5 mg of albuterol in continuous breathing treatments for patients <15 kg and 15 mg 15 kg.



Back in the day when I was doing my fellowships we used undiluted (0.5%) continuous albuterol where doses ranging between 60-90 mg/hr were used. An abstract of our experience was published in Ped Emergency Care (Linzer J, Vance C, Letorneau M. 1996. Safety of continuously nebulized undiluted albuterol in children with severe acute asthma. Pediatr Emerg Care 12:328.). The average heart rate on presentation was 150.9 bpm and at disposition from the ED 162.3 bpm. No clinically significant dysrhythmias were noted.



Unlike adults, there is a direct dose-response relationship of albuterol in kids which is one of the reasons we use relatively higher does than in adults. Additionally, younger, healthier hearts can tolerated high heart rates longer than older adults (this author included). We generally found that the heart rate would peak and then decrease as the patient's bronchoconstriction started to reverse.



Overall, the current albuterol dosing in children even with the associated side effects of nausea, vomiting and tachycardia, is more effective and relatively safer then the old "3 epis and a Sus-Phrine" or IV aminophylline or isoproterenol.



Jeff



Jeffrey Linzer Sr., MD, FAAP, FACEP
Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine
Associate Medical Director for Compliance
EPG/Division of Pediatric Emergency Medicine
Lead Physician, ICD-10-CM Transition Core Leadership Team
Children's Healthcare of Atlanta

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-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Marty Herman
Sent: Tuesday, February 10, 2015 10:45 AM
To: [log in to unmask]
Subject: Re: continuous albuterol in young asthmatics



JIm,

I have seen it but then again can't recall if the kid was < 2.

Might try Xopenex for that kid in the future..

Of course in a young child with a healthy heart, not sure 200-210 is a problem for a few hours, as long as they are well oxygenated...





I remember when I started my career, We would start aminophylline drips on kids that failed to break with 3 sub cut epi shots.  if that didn't work and the kid was in severe distress, asthmatics were put on an isoproterenol drip. we would start an A line to monitor their heart rates and titrate the Isoproterenol to keep the HR at 200.  Never witnessed or heard of any reactions to that protocol.

when that fell out of favor we began using tertbutaline drips for the worst cases.

of course epi was also an alternative for infusions..

with all these powerful agonist, only witnessed hr > 200 a few times..



so I am thinking in your case it was just a rare event..



Marty

Martin Herman, M.D.



Pediatric Emergency Medicine

Sacred Heart Children's Hospital



Email: [log in to unmask]<mailto:[log in to unmask]>



> Date: Mon, 9 Feb 2015 18:16:24 -0500

> From: [log in to unmask]<mailto:[log in to unmask]>

> Subject: continuous albuterol in young asthmatics

> To: [log in to unmask]<mailto:[log in to unmask]>

>

> We are initiating continuous albuterol for asthmatics in the ED (10 mg/hr for kids < 15kg, 15 mg/hr for > 15kg).  I have had 2 kids, each about 18-20 months old, develop heart rates to 210-220/min with this treatment.  Neither had SVT, both were early in the process of continuous (not prolonged therapy).  Has anyone had this experience with younger asthmatics?  Not sure if this is just bad luck or something we should include in protocol (continuous for 2 years and older only).  Would appreciate any input.

> Thanks

> Jim Naprawa

> Nationwide Children's Hospital

> Columbus, OH



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