Continuous intravenous terbutaline for pediatric status asthmaticus

Stephanopoulos, Dimitrios E.; Monge, Roberto; Schell, Kenneth H.; Wyckoff, Pamela; Peterson, Bradley M.

doi:10.1097/00003246-199810000-00033

Cited by 54 publications

(28 citation statements)

References 8 publications

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“…There is increasing evidence that ␤ 2 -AR agonists can reduce BP and renal function (10 -12). Stephanopoulos et al (10) reported that ␤ 2 -AR agonists significantly decreased diastolic BP in children with asthma. On the other hand, Hashimoto et al (11) indicated that urine flow, glomerular filtration, renal blood flow, free water clearance and excretion of electrolytes were reduced by administration of ␤ 2 -AR agonists which was associated with a concomitant fall in systemic BP.…”

Section: Discussionmentioning

confidence: 99%

Renal Effects of β2-Adrenoceptor Agonist and the Clinical Analysis in Children

2007

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ABSTRACT:The objectives of the present study were to define the contribution of ␤ 2 -adrenoceptors(␤ 2 -ARs) agonists to renal physiology and to investigate whether over-expression of renal ␤ 2 -ARs might be implicated in the pathogenesis of renal dysfunction in children as an adverse effect of ␤ 2 -AR activation. The renal functional responses to the systemic injection of the ␤ 2 -AR agonist terbutaline in Wistar rats over-expressing renal ␤ 2 -AR were compared with those of nontreated rats. Furthermore, we evaluated intrarenal ␤ 2 -AR expression in 34 children (age 2-15 y) and the changes in serum creatinine levels of 99 children (age 1-15 y) who received ␤ 2 -AR agonists. The animal study showed that the suppression of glomerular function by terbutaline was associated with a reduction in systemic blood pressure and over-expression of renal ␤ 2 -ARs. Moreover, in rats over-expressing renal ␤ 2 -ARs, administration of terbutaline resulted in a high mortality rate after a lipopolysaccharide challenge. The clinical study showed that renal ␤ 2 -AR expression gradually increased with age and was up-regulated by steroid therapy. These findings indicate that the renal dysfunction caused by ␤ 2 -AR agonists can be explained, at least partly, by enhanced ␤ 2 -AR expression in the kidney. This may have important implications for the use of ␤ 2 -AR agonists in the treatment of sick children with, for example, steroid therapy or endotoxemia. ␤ 2 -adrenoceptor (␤ 2 -AR) agonists are used as standard agents in the treatment of bronchial asthma and chronic bronchitis. The majority of the ␤ 2 -AR agonists is eliminated via the kidneys in an unchanged form and it is likely that the compound will exert pharmacological effects during its passage along the nephron. However, these pharmacological effects have, to our knowledge, not been taken into consideration when using these compounds in clinical practice because the significance of ␤ 2 -ARs in the regulation of renal function remains unclear.Renal ␤ 2 -ARs in the rat are predominantly localized to the renal tubular epithelia and the membranes of smooth muscle cells in the renal vasculature (1). From this morphologic evidence, the possibility arises that ␤ 2 -AR activation may impact on glomerular function and thereby sodium and water handling at different nephron segments. We recently demonstrated that injection into the kidney of an adenoviral construct expressing the human ␤ 2 -AR gene induced a widespread increase in ␤ 2 -AR expression in the renal glomeruli and tubules, which was associated with enhanced glomerular filtration and sodium re-absorption as a consequence of overactivation of renal ␤ 2 -ARs (2). Since the level of ␤ 2 -AR expression will importantly determine the magnitude of ␤ 2 -AR-mediated responses following administration of a ␤ 2 -AR agonist (3), the density of intrarenal ␤ 2 -AR expression may determine the impact of ␤ 2 -AR agonists on renal function. However, there have been no studies evaluating the relationship between intrarenal ␤ 2 -AR expression a...

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Section: Discussionmentioning

confidence: 99%

Renal Effects of β2-Adrenoceptor Agonist and the Clinical Analysis in Children

2007

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“…55 To accelerate the therapeutic effect, an intravenous loading dose of 2 to 10 mcg/kg infused for 10 minutes is recommended, followed by a continuous infusion of 0.1 to 10 mcg/kg/min. 83 Because of differences in drug metabolism and clinical effect among patients, dose adjustment should be assessed at regular intervals. Usually the starting dose is 0.4 mcg/kg/min; it is titrated to achieve the desired clinical effect with increments of 0.2 to 0.4 mcg/ kg/min every 15 to 30 minutes depending on the patient's clinical response and on adverse drug reactions.…”

Section: Terbutalinementioning

confidence: 99%

“…82 The most reported adverse drug reactions with β-agonists are tachycardia, tremors, and nausea. Cardiovascular effects include diastolic hypotension, 83 arrhythmias, and prolonged QTc interval with hypokalemia. 84 Hypokalemia is the result of intracellular potassium shifting from an increased number of sodium-potassium pumps.…”

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confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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“…A dose máxima referida seria de 4 µg/kg/min. Atualmente, uma vez iniciada a infusão em taxas de 1 µg/kg/min, aumenta-se o aporte da droga em intervalos freqüentes, até obtenção de uma resposta clínica desejada, ou o aparecimento de sinais relacionados a uma não tolerância por parte do paciente, podendo atingir taxas de infusão de 10 a 15 µg/kg/min 8,30,34,[37][38][39] . Recentemente, baseado na farmacocinética e na farmacodinâmica destas drogas, Shan sugeriu um novo protocolo para condução da infusão.…”

Section: Terapia Intravenosa: Papel Dos ß 2 -Agonistasunclassified

Controversies in the pharmacological management of acute asthma in children

et al. 2002

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Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children.Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases.Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of ß2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. Conclusions:Inhaled ß2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. Either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. Patients who are refractory to conventional treatment and develop severe acute asthma should receive ß2-agonist drugs intravenously, provided they are properly monitored. Methylxanthine and magnesium sulfate should be considered a second choice for selected patients.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: acute asthma, beta-agonist, magnesium sulfate, aminophylline. ResumoObjetivo: apresentar uma revisão acerca de questões controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline.Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Questões relacionadas à utilização de inaladores dosimetrados versus nebulizadores, o papel das drogas ß 2 -adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, são abordados de maneira crítica.Conclusões: os ß 2 -agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de eleição para episódios agudos de asma na população pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espaçadores, são efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utilização de drogas ß 2 -agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: asma aguda, beta-agonistas, sulfato de magnésio, aminofilina.

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Continuous intravenous terbutaline for pediatric status asthmaticus

Cited by 54 publications

References 8 publications

Renal Effects of β2-Adrenoceptor Agonist and the Clinical Analysis in Children

Renal Effects of β2-Adrenoceptor Agonist and the Clinical Analysis in Children

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Controversies in the pharmacological management of acute asthma in children

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