Systemic Beta-Agonist Use and Ventilatory Support in Pediatric Critical
Asthma: A National Cohort Study
Abstract
Objective(s): To evaluate the impact of epinephrine and terbutaline use
on ventilatory support in children admitted to the intensive care unit
(ICU) with critical asthma. Methods: Data were obtained with the
Pediatric Health Information System (PHIS) database for children aged 2
to 18 years admitted to the ICU with a diagnosis of asthma exacerbation
from January 1, 2016 to December 31, 2023. Primary outcomes included
non-invasive ventilation (NIV) and/or invasive mechanical ventilation
(IMV) use one day after receipt of terbutaline and/or epinephrine.
Secondary outcomes included adverse events from systemic beta-agonists,
including arrhythmias and elevated troponins. Results: Our study
population included 53,328 patient encounters. Terbutaline and
epinephrine were associated with decreased odds of NIV (terbutaline: OR:
0.52, 95% CI: 0.44-0.63; epinephrine: OR: 0.49, 95% CI: 0.43-0.55) and
IMV (terbutaline: OR: 0.51, 95% CI: 0.42-0.61; epinephrine: OR: 0.34,
95% CI: 0.29-0.41). There were no differences in adverse events in the
terbutaline group when compared to the epinephrine group for both
arrhythmia and elevated troponins (arrhythmia: terbutaline = 1.9%,
epinephrine = 1.7%, p = 0.6; elevated troponins: terbutaline = 0.1%,
epinephrine = 0.1%, p > 0.9). Conclusions: Systemic
beta-agonist use was associated with decreased odds of receiving both
NIV and IMV in pediatric critical asthma. There were low rates of
arrhythmia and elevated troponin overall, with no differences found
between those who received epinephrine or terbutaline. Our findings
should inform future clinical trials to evaluate the use of systemic
beta-agonists and implementation of guidelines in escalation in critical
asthma.