TY - JOUR
T1 - Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU
T2 - a randomized controlled trial
AU - Boeschoten, Shelley A.
AU - Buysse, Corinne M. P.
AU - de Winter, Brenda C. M.
AU - on behalf of the Dutch collaborative PICU research network (SKIC)
AU - van Rosmalen, Joost
AU - de Jongste, Johan C.
AU - de Jonge, Rogier C.
AU - Heisterkamp, Sabien G. J.
AU - van Woensel, Job B.
AU - Kneyber, Martin C. J.
AU - van Zwol, Annelies
AU - Boehmer, Annemie L. M.
AU - de Hoog, Matthijs
N1 - Funding Information: This study was financially supported by the Dutch Foundation for Asthma Prevention (Stichting Astma Bestrijding) and Ammodo (Institute of Art and Science). Funding Information: Research consortium SKIC members (Dutch Collaborative PICU Research Network): Amsterdam University Medical Centers, Amsterdam, the Netherlands: Eric Haarman and Berber Kapitein; Wilhelmina Children’s Hospital - University Medical Center Utrecht, Utrecht, the Netherlands: Roelie Wösten-van Asperen; University Medical Center Nijmegen, Nijmegen, the Netherlands: Joris Lemson; Maastricht University Medical Center, Maastricht, the Netherlands: Dick van Waardenburg; Leiden University Medical Center, Leiden, the Netherlands: Heleen Bunker and Carole Brouwer Publisher Copyright: © 2022, The Author(s).
PY - 2022/10/1
Y1 - 2022/10/1
N2 - The optimal dose regimen for intravenous (IV) treatment in children with severe acute asthma (SAA) is still a matter of debate. We assessed the efficacy of adding a salbutamol loading dose to continuous infusion with salbutamol in children admitted to a pediatric intensive care unit (PICU) with SAA. This multicentre, placebo-controlled randomized trial in the PICUs of four tertiary care children’s hospitals included children (2–18 years) with SAA admitted between 2017 and 2019. Children were randomized to receive either a loading dose IV salbutamol (15 mcg/kg, max. 750 mcg) or normal saline while on continuous salbutamol infusion. The primary outcome was the asthma score (Qureshi) 1 h after the intervention. Analysis of covariance models was used to evaluate sensitivity to change in asthma scores. Serum concentrations of salbutamol were obtained. Fifty-eight children were included (29 in the intervention group). Median baseline asthma score was 12 (IQR 10–13) in the intervention group and 11 (9–12) in the control group (p = 0.032). The asthma score 1 h after the intervention did not differ significantly between the groups (p = 0.508, β-coefficient = 0.283). The median increase in salbutamol plasma levels 10 min after the intervention was 13 μg/L (IQR 5–24) in the intervention group and 4 μg/L (IQR 0–7) in the control group (p = 0.001). Side effects were comparable between both groups. Conclusion: We found no clinical benefit of adding a loading dose IV salbutamol to continuous infusion of salbutamol, in children admitted to the PICU with SAA. Clinically significant side effects from the loading dose were not encountered.What is Known:• Pediatric asthma guidelines struggle with an evidence-based approach for the treatment of SAA beyond the initial steps of oxygen suppletion, repetitive administration of inhaled β2-agonists, and systemic steroids.• During an SAA episode, effective delivery of inhaled drugs is unpredictable due to severe airway obstruction.What is New:• This study found no beneficial effect of an additional loading dose IV salbutamol in children admitted to the PICU.• This study found no clinically significant side effects from the loading dose.
AB - The optimal dose regimen for intravenous (IV) treatment in children with severe acute asthma (SAA) is still a matter of debate. We assessed the efficacy of adding a salbutamol loading dose to continuous infusion with salbutamol in children admitted to a pediatric intensive care unit (PICU) with SAA. This multicentre, placebo-controlled randomized trial in the PICUs of four tertiary care children’s hospitals included children (2–18 years) with SAA admitted between 2017 and 2019. Children were randomized to receive either a loading dose IV salbutamol (15 mcg/kg, max. 750 mcg) or normal saline while on continuous salbutamol infusion. The primary outcome was the asthma score (Qureshi) 1 h after the intervention. Analysis of covariance models was used to evaluate sensitivity to change in asthma scores. Serum concentrations of salbutamol were obtained. Fifty-eight children were included (29 in the intervention group). Median baseline asthma score was 12 (IQR 10–13) in the intervention group and 11 (9–12) in the control group (p = 0.032). The asthma score 1 h after the intervention did not differ significantly between the groups (p = 0.508, β-coefficient = 0.283). The median increase in salbutamol plasma levels 10 min after the intervention was 13 μg/L (IQR 5–24) in the intervention group and 4 μg/L (IQR 0–7) in the control group (p = 0.001). Side effects were comparable between both groups. Conclusion: We found no clinical benefit of adding a loading dose IV salbutamol to continuous infusion of salbutamol, in children admitted to the PICU with SAA. Clinically significant side effects from the loading dose were not encountered.What is Known:• Pediatric asthma guidelines struggle with an evidence-based approach for the treatment of SAA beyond the initial steps of oxygen suppletion, repetitive administration of inhaled β2-agonists, and systemic steroids.• During an SAA episode, effective delivery of inhaled drugs is unpredictable due to severe airway obstruction.What is New:• This study found no beneficial effect of an additional loading dose IV salbutamol in children admitted to the PICU.• This study found no clinically significant side effects from the loading dose.
KW - Children
KW - IV salbutamol bolus
KW - Intensive care
KW - Severe acute asthma, Therapy
KW - Status asthmaticus
UR - http://www.scopus.com/inward/record.url?scp=85135291632&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00431-022-04576-8
DO - https://doi.org/10.1007/s00431-022-04576-8
M3 - Article
C2 - 35922522
SN - 0340-6199
VL - 181
SP - 3701
EP - 3709
JO - European journal of pediatrics
JF - European journal of pediatrics
IS - 10
ER -