Purpose of the Study. Comparison of continuously nebulized albuterol (0.3 mg/kg/hour) to intermittent hourly albuterol (0.3 mg/kg/dose) in the treatment of status asthmaticus.

Population. Seventeen patients (average, 5 years; range, 1.8 to 16 years) admitted to the Pediatric Intensive Care Unit (PICU) with severe status asthmaticus (asthma scored >5, range 0 to 10) who were nonresponsive to outpatient management with β-agonist, oxygen, corticosteroid, and theophylline.

Methods. Randomized, nonblinded trial using small volume nebulizer for both modalities of treatment. The minimum albuterol dose was 5 mg/hour and maximum dose was 10 mg/hour.

Results. The two groups did not differ in demographics, vital signs, or blood gas results. Improvement in clinical score was significant (8 to 6) in the continuous group as compared with the intermittent nebulized group (7 to 6.8) during the first 4 hours of therapy. The mean time to reach an asthma score of <5 was 12 hours (range, 4 to 24 hours) for continuous group compared with 18 hours (range, 12 to 24 hours) for the intermittent group. One patient in the intermittent group failed to respond after 12 hours and was removed from the protocol. Another patient in the intermittent group was readmitted to the PICU 60 hours after discharge for a severe episode of status asthmaticus. No significant changes in electrocardiogram, vital signs, on lab data occurred except for hypokalemia in one patient in the continuous group who was not given supplemental potassium. The respiratory therapist's time commitment for the continuous group was approximately 50% less than for intermittent therapy group.

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