Effects of Nebulized Bronchodilator Therapy on Heart Rate and Arrhythmias in Critically Ill Adult Patients

The effect of nebulized salbutamol on atrial electrical properties in mechanically ventilated critically ill patients — a randomized, double-blind study

“…The importance of this fact is stressed by the observation that inhalational administration of this drug, which should theoretically reduce its systemic effects [12], is associated electrophysiological influence on myocardial cells [13]. Data about clinical significance of this finding are conflicting stating that beta mimetics can increase the risk of cardiac morbidity among patients with chronic obstructive pulmonary disease [14] as well as that there is no influence of bronchodilatory treatment among critically ill on heart rate (HR) and incidence of arrhythmias [15]. It is also noticeable that most of the studies about this topic do not cover the ICU population.…”

Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma

“…Several recent studies evaluating levalbuterol in pediatric or critically ill patients have reported results similar to the findings of our analysis. 32,37 Additionally, our study only evaluated the short-term use of inhaled nebulizers for treatment of acute exacerbations. Many patients use metered-dose inhalers containing levalbuterol or albuterol on a fairly regular basis for chronic disease control.…”

Effect of bronchodilator treatment on the incidence of postoperative atrial fibrillation after cardiac surgery

“…22 Khorfan et al assessed the effects of albuterol or levalbuterol treatment in critically ill patients with acute airflow obstruction, and reported no significant tachycardia or tachyarrhythmias when recommended doses were used for both agents. 21 Seven new arrhythmias occurred (.8%) in 878 treatments, and most of them were transient atrial and ventricular arrhythmias, with only 1 episode of atrial fibrillation. Levalbuterol may induce more arrhythmias because of its more potent b 2 -agonist effect, but some patients may require a higher dose of albuterol than levalbuterol during acute bronchospastic events, which may predispose them to more arrhythmias.…”

“…Some studies reported increased arrhythmias, such as tachycardia, with bronchodilator treatment, whereas others found no difference in the precipitation of arrhythmia. [19][20][21][22] The arrhythmogenic effects of albuterol and levalbuterol have been evaluated in the literature. Although a similar increase in heart rate for both agents was reported, albuterol treatment at high doses led to a higher serum level of R-albuterol and a higher mean heart rate, compared with levalbuterol.…”

“…[16][17][18] So far, no evidence supports the need to substitute levalbuterol for albuterol to avoid tachycardia or tachyarrhythmias. 21 This study was designed to examine the association between the incidence of POAF in cardiac surgery patients and postoperative bronchodilator treatment (specifically albuterol, levalbuterol, or both).…”