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I must say, I was a little skeptical-despite the quality of the recent
data.  I guess the MOLECULE OF THE YEAR mentality that had gripped
medicine in recent years has prompted this.  However, I recently took
care of a 3 mo (4 kg) ex 35 weeker who presented shocky and apneic and
had a "bronchiolitis" clinical history and constelation of signs.  He
had received continuous albuterol (2.5 mg/hr) and I planned to
intubate him.  He had periods of prolonged pauses though he
maintained his Sao2 in the 99-100% range.  I thought that prior to
intubating him I would try a dose of aerosolized epinephrine.  Wow!
 
He immediately improved in his work of breathing, activity level,
mental status and-here's where I was convinced I wasn't imagining
things-his heart rate FELL from the 190s bpm to 150s bpm.  This was
after sustained 190s despite 30cc/kg fluid bolus and was more
temporally related to (during) the racemic epi.
 
Now I have fairly good objective data AND a little experience. I'll
use it again and see where all this pans out.  The n of 1
notwithstanding, it's good to have more than albuterol in the
cupboard if a little one has bronchiolitis.  And don't even mention
ribavirin...
 
Also, what doses of continuous albuterol are being used by ED
physicians for bronchiolitis and asthma?  My impression is that kids
are generally being underdosed...
 
Michael Forbes, MD
Pediatric Critical Care
Allegheny University Hospitals, Allegheny General
Pittsburgh, PA
412.359.3131
 
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