Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and UW Health American Family Children's Hospital, UW Health, Madison, Wisconsin.
UW Health University Hospital, Madison, Wisconsin.
Respir Care. 2023 Jun;68(6):734-739. doi: 10.4187/respcare.10747. Epub 2023 Jan 20.
Continuous aerosolized β agonist, namely albuterol, is the most commonly used therapy for critical asthma. Benzalkonium chloride is a preservative present in some formulations of aerosolized albuterol solutions that can induce bronchospasm. Recent studies have shown that inhalation of albuterol containing benzalkonium chloride might induce unintended bronchoconstriction and poor outcomes. This study aimed to investigate whether using albuterol solutions containing benzalkonium chloride results in prolonged hospital length of stay (LOS).
This was a retrospective cohort study of pediatric subjects admitted to the pediatric ICU (PICU) and treated with continuous albuterol. Data were collected and compared before and after a change to benzalkonium chloride-containing solutions. Subjects who were treated with preservative-free solutions were used as control. The primary outcome was PICU and hospital LOS; secondary outcomes included the duration of continuous albuterol and use of adjunctive therapies.
A total of 266 admissions were included in the study. One hundred forty subjects (52.6%) were exposed to benzalkonium chloride. Median age and severity of illness scoring were similar between groups. The initial dose of continuous albuterol was significantly higher in the benzalkonium chloride group (median 15 interquartile range [IQR] 10-20 mg/h) compared to the preservative-free group (median 10 IQR 10-20 mg/h) ( < .001). PICU LOS was longer for the preservative-free group, 2.5 (IQR 1.4-4.6) d vs 1.8 (IQR 1.1-2.9) d for benzalkonium chloride group ( = .002). There was no significant difference in duration of continuous albuterol therapy ( = .16) or need for adjunctive respiratory support (heliox [ = .32], noninvasive ventilation [ = .81], and invasive mechanical ventilation [ = .57]).
In contrast to published literature showing that benzalkonium chloride may be associated with a longer duration of continuous albuterol nebulization and hospital LOS, our study demonstrated that benzalkonium chloride-containing albuterol is safe for continuous nebulization in critically ill children and not associated with worse outcomes.
持续雾化β激动剂，即沙丁胺醇，是治疗严重哮喘最常用的疗法。苯扎氯铵是一些沙丁胺醇雾化溶液中的防腐剂，可诱发支气管痉挛。最近的研究表明，吸入含苯扎氯铵的沙丁胺醇可能会引起意外的支气管收缩和不良后果。本研究旨在探讨使用含苯扎氯铵的沙丁胺醇溶液是否会导致住院时间延长。
这是一项回顾性队列研究，纳入了入住儿科重症监护病房（PICU）并接受持续沙丁胺醇治疗的儿科患者。在改用含苯扎氯铵溶液前后收集并比较数据。使用不含防腐剂的溶液治疗的患者作为对照。主要结局为 PICU 和住院 LOS；次要结局包括持续沙丁胺醇的持续时间和辅助治疗的使用。
共纳入 266 例住院患者。140 例（52.6%）患者接触过苯扎氯铵。两组间年龄和疾病严重程度评分中位数相似。苯扎氯铵组的初始连续沙丁胺醇剂量明显高于不含防腐剂组（中位数 15 四分位距[IQR] 10-20 mg/h）（<.001）。不含防腐剂组的 PICU LOS 较长，为 2.5（IQR 1.4-4.6）d，而苯扎氯铵组为 1.8（IQR 1.1-2.9）d（=.002）。持续沙丁胺醇治疗时间（=.16）或需要辅助呼吸支持（氦氧混合气[=.32]、无创通气[=.81]和有创机械通气[=.57]）无显著差异。
与发表的文献表明苯扎氯铵可能与连续雾化沙丁胺醇时间延长和住院 LOS 延长有关不同，我们的研究表明，含苯扎氯铵的沙丁胺醇在危重症儿童中持续雾化是安全的，与不良结局无关。
