Intravenous Salbutamol for Children With Severe Acute Asthma on a Dutch Pediatric Ward: An Effective and Child-Friendly Alternative

Abstract

Background: Administration of intravenous (IV) salbutamol is a widely used intervention for managing severe acute asthma (SAA) in children, although evidence is limited. Traditionally, IV salbutamol is an indication for admission to a Pediatric Intensive Care Unit (PICU), however, recent Dutch guidelines allow this treatment to be initiated on a medium care pediatric ward. This study evaluated the efficacy of IV salbutamol treatment for children with SAA on two pediatric wards in the Netherlands.

Methods: In this retrospective multicenter cohort study, we included children with SAA who have been treated with IV salbutamol between June 2021 and December 2023. The primary outcome was the number of children successfully treated with IV salbutamol without being transferred to a PICU. Secondary outcomes included severity of side effects and complications.

Results: A total of 103 patients with 112 severe asthma exacerbations were included. Among these children, 46% were successfully treated on the pediatric ward. The remainder were transferred to a PICU, primarily due to exceeding the maximum allowed dose by protocol (1.0-1.5 mcg/kg/min) without an adequate response. Adverse events (e.g. hypokalemia, hyperglycemia, lactic acidosis, and hypotension) were observed in 61% of the children. Three serious adverse events were observed, no children were intubated nor were there any deaths.

Conclusion: Children with SAA can be treated effectively with IV salbutamol on a Dutch pediatric ward with medium care facilities, since 46% of the children did not require a transfer to the PICU.

Keywords: IV salbutamol; children; pediatric; pediatric intensive care; severe acute asthma; therapy.