A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation*

Abstract

Similar statistically significant bronchodilation occurred after all three bronchodilators as indicated by a decrease in peak inspiratory pressure and respiratory system resistance, but these changes were small and probably clinically insignificant. However, side effects of bronchodilators, such as tachycardia, also occurred, and these may be clinically significant. Thus the benefit of bronchodilator treatment in these patients is small, does not differ among the drugs we studied and of questionable value.

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…56,61 One study in a critical care setting showed a small decrease in inspiratory resistance after albuterol in one group and levalbuterol in another group, but therapy was accompanied by clinically significant tachycardia. 62 This small clinical change occurring with significant adverse effects does not justify recommending albuterol for routine care.…”

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

“…Of these, 5 infants were recruited from the MICU, 6 were recruited from the ICP, and 4 from the Inpatient Units. There were 10 males and 5 females with a median age of 2.0 (0.4-18) months, median weight of 5.8 (3)(4)(5)(6)(7)(8)(9)(10)(11) kg and median height of 60 (50-84) cm. Median time to acute stabilization was 4 (1-6) days, time between initial and final CO recording was 2.5 (0.8-7.2) days and length of hospitalization was 3.6 (1.6-8.9) days.…”

“…Heart rate (HR) is generally used as a surrogate for CO but can be misleading with infants with RSV bronchiolitis, who tend to be tachycardic due to various factors including medical interventions [11,12]. Clinical exam may be suboptimal [13] to determine CO, as infants with RSV bronchiolitis typically have elevated HR, high respiratory rate (RR), pulmonary adventitious sounds and a normal heart size on radiological exam.…”

Life-Threatening RSV Infections in Children

“…Recently, Levin and co-workers confirmed the absence of beneficial effect of bronchodilators (i.e. norepinephrine, levalbuterol, and racemic albuterol) (Levin et al, 2008).…”