The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

A Report of Pre & Post Heart Rates of Newborn and Pediatric Patients Receiving Albuterol Via Small Volume Nebulizer.



James Keenan BS RRT-NPS FAARC, Julie Ballard BS RRT-NPS, Kimberly Bennion BS RRT-NPS. Primary Children's Medical Center, Salt Lake City, Utah.

Introduction: An increase in heart rate(HR) is one of the reported side effects of patients receiving Albuterol (Alb) small volume nebulizer (SVN) treatments (tx). Pharmaceutical manufacturers of Alb suggest that dosing should be weight specific for newborn and pediatric patients (pts) to prevent this side effect. Newborn and pediatrics Respiratory Care Practitioners (RCP's) at our facility have anecdotally reported that they have seen an increased HR in only a relatively few number of pts, even those receiving 2.5 mg or continuous SVN Alb. Therefore, we sought to retrospectively examine the pre-tx and post-tx HR's of infants and children receiving 2.5mg SVN Alb over an eight-year period.

Methods:
At Primary Children's Medical Center (PCMC) all pt data is saved electronically. Using the electronic data, queries can be run for analysis. For this study we queried all patients since 1996 that received SVN tx's with the following criteria: Inclusion criteria: All pts, all diagnoses, receiving 2.5 mg Alb SVN tx's 18 years of age and younger. Tx's were given with mouth piece or mask (face or tracheostomy) or inline with a ventilator. Exclusion criteria: Tx's containing any combination of other medications with the Alb (i.e. Atrovent). Pts whose post-tx HR decreased. Pts receiving continuous tx's.

RESULTS:
Table one reports our findings categorized by age. Of the total number of 35,801 treatments queried, 6,688 (19%) were given through an artificial airway (i.e. endotracheal, trachestomy tube).

Age # Pts # Txs Txs/ Pt HR Pre HR Post HR change % HR change # (%) txs ↑HR > 20%
0-5 months 495 2952 6.0 151(19) [59-215] 159(20) [59-230] 8 (8) [0-65] 5 (6)  [0-48] 81 (2.7)
6-11 months 301 2317 7.7 140(20) [72-210] 146(21) [80-220] 7 (8) [0-66] 5 (7) [0-59] 68 (2.9)
1-2 yrs 568 3734 6.6 133(22) [64-220] 140(22) [68-221] 7 (8) [0-79] 5 (7)  [0-69] 115 (3.1)
3-5 yrs 326 4038 12.4 114(21) [50-200] 120(22) [56-203] 6 (7) [0-56] 6 (7) [0-74] 150 (3.7)
6-8 yrs 232 3332 14.4 102(18) [53-186] 107(19) [58-199] 5 (6) [0-80] 5 (7) [0-67] 103 (3.1)
9-11 yrs 273 5379 19.7 94(16) [46-200] 99(17) [52-230] 5 (6) [0-50] 6 (7) [0-69] 201 (3.7)
12-18 yrs 587 14,049 24.0 86(13) [48-170] 91(14) [52-195] 5 (6) [0-62] 6 (7)  [0-72] 590 (4.2)
All pts 2782 35,801 12.9 106(28) [46-220] 111(29) [52-230] 6 (7) [0-80] 6 (7)  [0-74] 1308 (3.7)


Data reported by Mean (SD) [Range]

Discussion: At PCMC we feel that an increase in HR up to 20% is acceptable. In the results table we state the number of pts whose post-SVN tx HR increased > 20%. Of the 35,801 patients queried, only 1,308 (3.7%) had greater than 20% increase. For those pts, further monitoring, or possible discontinuation of that tx would have been recommended. In those relatively few cases, we suggest lowering the dose of Alb or changing to another medication. We feel it is significantly noteworthy to mention that 25% (8,892 pts) were excluded because their HR's had decreased and are not reported in the results table.

CONCLUSION:
There is no statistically significant increase in heart rates in pts receiving 2.5 mg SVN Alb tx in patients 18 years of age and younger in our study. We feel that 3.7% of those pts whose heart rates increased greater than 20% does not warrant weight base dosing for Alb, and that 2.5 mg is an acceptable starting dose for newborn and pediatric pts. We also conclude that weight base dosing is unnecessary and may increase the number of SVN treatments given.

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