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Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial

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....

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Autores principales: Boeschoten, Shelley A., Buysse, Corinne M. P., de Winter, Brenda C. M., van Rosmalen, Joost, de Jongste, Johan C., de Jonge, Rogier C., Heisterkamp, Sabien G. J., van Woensel, Job B., Kneyber, Martin C. J., van Zwol, Annelies, Boehmer, Annemie L. M., de Hoog, Matthijs
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508206/
https://www.ncbi.nlm.nih.gov/pubmed/35922522
http://dx.doi.org/10.1007/s00431-022-04576-8
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author Boeschoten, Shelley A.
Buysse, Corinne M. P.
de Winter, Brenda C. M.
van Rosmalen, Joost
de Jongste, Johan C.
de Jonge, Rogier C.
Heisterkamp, Sabien G. J.
van Woensel, Job B.
Kneyber, Martin C. J.
van Zwol, Annelies
Boehmer, Annemie L. M.
de Hoog, Matthijs
author_facet Boeschoten, Shelley A.
Buysse, Corinne M. P.
de Winter, Brenda C. M.
van Rosmalen, Joost
de Jongste, Johan C.
de Jonge, Rogier C.
Heisterkamp, Sabien G. J.
van Woensel, Job B.
Kneyber, Martin C. J.
van Zwol, Annelies
Boehmer, Annemie L. M.
de Hoog, Matthijs
author_sort Boeschoten, Shelley A.
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00431-022-04576-8.
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spelling pubmed-95082062022-09-25 Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial Boeschoten, Shelley A. Buysse, Corinne M. P. de Winter, Brenda C. M. van Rosmalen, Joost de Jongste, Johan C. de Jonge, Rogier C. Heisterkamp, Sabien G. J. van Woensel, Job B. Kneyber, Martin C. J. van Zwol, Annelies Boehmer, Annemie L. M. de Hoog, Matthijs Eur J Pediatr Research 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00431-022-04576-8. Springer Berlin Heidelberg 2022-08-03 2022 /pmc/articles/PMC9508206/ /pubmed/35922522 http://dx.doi.org/10.1007/s00431-022-04576-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Boeschoten, Shelley A.
Buysse, Corinne M. P.
de Winter, Brenda C. M.
van Rosmalen, Joost
de Jongste, Johan C.
de Jonge, Rogier C.
Heisterkamp, Sabien G. J.
van Woensel, Job B.
Kneyber, Martin C. J.
van Zwol, Annelies
Boehmer, Annemie L. M.
de Hoog, Matthijs
Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title_full Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title_fullStr Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title_full_unstemmed Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title_short Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial
title_sort efficacy of a loading dose of iv salbutamol in children with severe acute asthma admitted to a picu: a randomized controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508206/
https://www.ncbi.nlm.nih.gov/pubmed/35922522
http://dx.doi.org/10.1007/s00431-022-04576-8
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