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Mark-
 
There are some limitations to the ipratropium data accumulated thus far. My biggest concern is
that the studies to data have not compared albuterol/atrovent to albuterol/placebo using maximal
doses of albuterol. When reading the methods section of these studies I am always impressed with
the fact that they are using significantly less albuterol than I use. This is particularly
important given that nearly every study has concluded that it is the 'moderate to severe' group
that receives the benefit. I usually treat this group with 1 mg/kg/hour of continuous albuterol.
For more details, see http://www.pediatric-emergency.com/zorc.htm.
 
Jay Fisher
 
Mark A Hostetler wrote:
 
> Since we're on the subject, I'm interested in how many are using multidose
> combination therapy (albuterol plus atrovent) for moderately severe to
> severe asthmatics in the ED during their first hour of treatment.
>
> The literature appears to support its use, and we're trying to develop a
> collaborative protocol which allows for that option.
>
> The two options we're considering is adding 1.0-1.5mg atrovent to the first
> hour's continuous albuterol, or completely taking the patient off from the
> continuous albuterol intermittently during the first hour to give 1-3
> individual atrovent nebs (0.5mg each) and then putting them back on.
>
> Respiratory therapy is adamantly opposed to combining agents, and very
> reluctant to give more than 0.5mg atrovent in the first 6hrs.
>
> Any thoughts?
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html