Effectiveness of Continuous Levalbuterol Versus Albuterol During a National Shortage: A Retrospective Observational Cohort Study.

INTRODUCTION

Bronchospasm requiring continuous inhaled albuterol is a common reason for pediatric intensive care unit (PICU) admission. Albuterol's racemic composition may contribute to adverse effects; therefore, levalbuterol [(R)-albuterol] may be used. This study aimed to determine if continuous inhaled levalbuterol is associated with a shorter duration of continuous inhaled bronchodilator therapy and less tachycardia compared to albuterol in PICU patients.

METHODS

This study utilized two periods of exclusive continuous inhaled levalbuterol use due to an albuterol shortage. PICU encounters receiving ≥ 12 h of continuous inhaled levalbuterol during those periods were compared to encounters receiving albuterol in the interim. Therapy duration and % change in median heart rate (HR) at 6-h epochs were compared between groups, and multilevel mixed effects models were created.

RESULTS

In 686 encounters, there was no difference in therapy duration between levalbuterol and albuterol groups (31.3 vs. 28.7 h, p = 0.22). There was no difference in % change in median HR at 6 (-1.0% vs. -1.3%, p = 0.54), 12 (-1.6% vs. -2.7%, p = 0.28), or 18 h (-2.5% vs. -4.1%, p = 0.38) from therapy initiation. Levalbuterol was not associated with therapy duration adjusting for age, technology dependence, respiratory rate category, and number of continuous intravenous bronchodilators (p = 0.13). Levalbuterol was not associated with % change in median HR at 12 h following therapy initiation after adjusting for age and respiratory rate category (p = 0.99).

CONCLUSION

Continuous inhaled levalbuterol was not associated with shorter therapy duration or lower HR compared to albuterol in PICU patients.