Monica Bogenschutz, BCPS, PharmD, BCPPS
Pharmacy Coordinator
n/a
Disclosure information not submitted.
Erica Terry, PharmD
Clinical Pharmacist
UW Health, United States
Disclosure information not submitted.
Eric Friestrom, PharmD
Clinical Pharmacist
UW Health, United States
Disclosure information not submitted.
Miranda Richard, RRT, NPS
Respiratory Therapist
UW Health – American Family Children's Hospital, United States
Disclosure information not submitted.
Michael Lasarev, M.S.
Biostatistician
University of Wisconsin School of Medicine and Public Health, United States
Disclosure information not submitted.
Joshua Vanderloo, PharmD, BCPS
Clinical Pharmacist and Drug Policy Program Pharmacist
UW Health, United States
Disclosure information not submitted.
Awni Al-Subu, MD
Associate Professor of Pediatrics
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Disclosure information not submitted.
Title: Continuous Albuterol Solutions With and Without Benzalkonium Chloride in Critically Ill Children
Introduction: Continuous aerosolized β2-agonist, namely, albuterol, is the most commonly used therapy for Status Asthmaticus. Benzalkonium chloride (BAC) is a preservative present in some formulations of aerosolized albuterol solutions that could produce bronchospasm by itself. Recent studies showed that inhalation of albuterol containing BAC may induce unintended bronchoconstriction, resulting in slower response, poorer outcomes, and prolonged hospital length of stay. This study aims to investigate whether the use of albuterol solutions containing BAC preservative result in worsened outcomes and prolong hospital length of stay (LOS).
Methods: A retrospective study of all pediatric patients admitted to the PICU and treated with continuous albuterol (CA) at tertiary children's hospital between January 2015 to April 2019. Data from patients' charts were collected and compared before and after the change to BAC solutions. Patients who were treated with BAC-free solutions were used as control. The primary outcome was ICU and hospital LOS. Secondary outcomes included the duration of continuous aerosolized albuterol, the use of adjunct therapies including intravenous bronchodilators, and the need for additional respiratory support.
Results: A total of 266 patient admissions were included in the study. One hundred forty patients (52.6%) were exposed to albuterol containing BAC. Median age and severity of illness scoring were similar between groups. The initial dose of CA was significantly higher in the BAC group median 15 (IQR: 10–20; p< 0.001) mg/hr compared to the BAC-free group (10 mg/hr [10–20]). Hospital LOS was significantly longer for the BAC-free group 3.3 (2.1-6.2) days vs. 2.6 (1.8-4.4) days for BAC group (p=0.008). There were no significant differences between both groups in total duration of CA therapy (p= 0.160) or the need for additional respiratory support [Heliox (p=0.319), NIPPV (p=0.720), and invasive mechanical ventilation (p=0.568)].
Conclusions: In contrast to published literature showing that BAC is associated with a longer duration of CA nebulization and hospital LOS, our study demonstrated that BAC-containing solutions are safe for continuous nebulization in critically ill children and are not associated with worse outcomes.