Introduction: Critical asthma is a common indication for admission to the pediatric intensive care unit. Continuous albuterol is a standard treatment approach to manage critical asthma symptoms, but there are no specific guidelines for dosing. Our objective was to compare the clinical outcomes of a 10mg/hr standard continuous albuterol dosing regimen with 15mg/hr regimen. Methods: This was a retrospective cohort study in an academic children’s hospital. We leveraged a natural experiment where, due to a national shortage of continuous albuterol, our standard protocol for critical asthma changed from 15mg/hr of continuous nebulized albuterol to 10mg/hr. We included all patients 2-18 years admitted to our pediatric intensive care unit (PICU) and given continuous albuterol from 2014-2022. Patients were assigned a treatment group based on their initial dosing of continuous albuterol. We used inverse propensity score weights (IPSW) to compare changes in symptoms using the pediatric asthma severity score (PASS) after 24 hours of treatment between groups, as well as length of PICU stay, hospital stay, and length of continuous albuterol. Results: Of the 1,486 patients who met inclusion criteria, 575 (38.7%) received 10mg/hr and 911 (61.3%) received 15mg/hr. In our IPSW analysis, we found no significant differences in symptom improvement (PASS score change at 24 hours), PICU length of stay, or hospital stay between the two groups. We did find a significantly lower length of time on continuous albuterol in the 10mg/hr group (13 hours 6-24 vs. 19 hours 9-31). The 10mg/hr group was significantly younger (4 years 3-7 vs. 8 years 6-12), and on aggregated analysis, received more albuterol per kilogram than the 15mg/hr group. However, when stratified by age (2-7 years and 7-18 years), the 15mg/hr group did receive more albuterol per kilogram in both age groups. Conclusions: A standard protocol of 10mg/hr of continuous albuterol for critical asthma in the PICU had no significantly different clinical outcomes than a higher dose of 15mg/hr and did result in less time on continuous albuterol.
Rogerson et al. (Sun,) studied this question.