Transient occult cardiotoxicity in children receiving continuous beta-agonist therapy
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Transient occult cardiotoxicity in children receiving continuous beta-agonist therapy Christopher L Carroll, Melinda Coro, Allison Cowl, Kathleen A Sala, Craig M Schramm Hartford, CT, USA
Methods: We conducted a retrospective review of children admitted to the intensive care unit (ICU) between May 2008 and April 2009, who were treated with continuous beta-agonist therapy (intravenous and nebulized). Results: Twenty of the 36 children treated with continuous albuterol had repeated serum troponin-T and lactate levels measured. Eleven patients (55%) were also treated with continuous intravenous terbutaline. Elevated levels of troponin-T levels were found in 25% of children, and elevated lactate levels were found in 60%. However, all returned to normal levels within 48 hours of ICU admission, despite continued beta-agonist therapy. No children experienced arrhythmias during therapy. There was no association between intravenous terbutaline use and elevated troponin-T [odds ratio (OR), 1.3; 95% CI, 0.2-10.3] or with elevated serum lactate (OR, 0.6; 95% CI, 0.1-3.7). There was also no association between elevated troponin-T or lactate and ICU or hospital length of stay. Conclusions: In this small study, a significant proportion of children had elevated serum troponin-T and lactate levels while receiving inhaled continuous beta-agonist therapy, irrespective of intravenous therapy. However, these abnormal values all returned to normal
Author Affiliations: Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA (Carroll CL, Coro M, Cowl A, Sala KA, Schramm CM) Corresponding Author: Christopher L Carroll, Division of Pediatric Critical Care, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA (Tel: 860 545-9805; Fax: 860 545-9800; Email: [email protected]) doi: 10.1007/s12519-014-0467-z ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2014. All rights reserved.
World J Pediatr, Online First, March 2014 . www.wjpch.com
within 48 hours of ICU admission and were not associated with increased duration of hospitalization. World J Pediatr March 2014; Online First Key words: asthma; beta-agonist; pediatric
Introduction
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cute asthma is commonly treated with betaagonist therapy, typically in the form of inhaled albuterol.[1-4] Initially, in children, this therapy is delivered via intermittent aerosol, then increased to continuous delivery if there is insufficient response to therapy.[1-4] Relatively high doses (20-30 mg/hour) are routinely used for hours to days in hospitalized children.[1,5] If there is continued failure in response, intravenous (IV) beta-agonist therapy is frequently used in children with poor air exchange.[1-3] In the United States, IV terbutaline is the most frequently used IV beta-agonist.[1,2] We have previously reported that in children admitted to the intensive care unit (ICU) with acute asthma at our institution, the median duration of continuous albuterol was 5 days, and almost 50%
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