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Continuous intravenous terbutaline for pediatric status asthmaticus.

OBJECTIVES: To determine the clinical effects of intravenous terbutaline at >0.4 microg/kg/min in children with status asthmaticus; to describe the clinical findings associated with such therapy, including creatinine phosphokinase-myocardial band isoenzyme (CPK-MB) concentrations, electrocardiographic alterations, and decreased diastolic blood pressure (DBP) with terbutaline usage; and to assess the requirement for epinephrine to counteract the decrease in diastolic blood pressure.

DESIGN: A retrospective review of children admitted with status asthmaticus who failed emergency room therapy and required intravenous terbutaline.

SETTING: San Diego Children's Hospital Pediatric Intensive Care Unit.

PATIENTS: Eighteen children with status asthmaticus, based on clinical and laboratory criteria, between September 1994 and July 1996.

INTERVENTIONS: Epinephrine was added for below-normal decreases in diastolic blood pressure.

MEASUREMENTS AND MAIN RESULTS: Continuous monitoring for arrhythmias, ST-segment changes, and DBP values during variations in the dose of intravenous terbutaline, with or without epinephrine. CPK-MB concentrations were determined in 15 of 18 patients.

CONCLUSIONS: Intravenous terbutaline was well tolerated in asthmatic children for < or =305 continuous hours and at varying doses up to a maximum of 10 microg/kg/min. There was no relationship between the magnitude of CPK-MB concentrations and the terbutaline or epinephrine doses used. Arrhythmias were rare and not related to either terbutaline or epinephrine doses. However, ST-segment depression did occur in two patients requiring high-dose epinephrine. Terbutaline significantly lowered DBP when used between 0.4 and 1.0 microg/kg/min, which required epinephrine to be initiated. Epinephrine was not required at terbutaline doses of >2 microg/kg/min. There was no mortality.

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