Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia

Charity H. Evans, Jeremiah J. Duby, Andrew J. Berry, Carol R. Schermer, Christine S. Cocanour

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. METHODS: The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered. RESULTS: Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement. CONCLUSION: Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)297-302
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2014

Fingerprint

Albuterol
Proxy
Bradycardia
Spinal Cord Injuries
Small Intestine
Injury Severity Score
Cervical Cord
Atropine
Therapeutics
Heart Rate
Blood Pressure
Trauma Centers
Adrenergic Receptors

Keywords

  • Spinal cord injury
  • albuterol
  • bradycardia

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia. / Evans, Charity H.; Duby, Jeremiah J.; Berry, Andrew J.; Schermer, Carol R.; Cocanour, Christine S.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 2, 01.02.2014, p. 297-302.

Research output: Contribution to journalArticle

Evans, Charity H. ; Duby, Jeremiah J. ; Berry, Andrew J. ; Schermer, Carol R. ; Cocanour, Christine S. / Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 2. pp. 297-302.
@article{d347b26cb36d4a789482a1d8b8557272,
title = "Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia",
abstract = "BACKGROUND: Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. METHODS: The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered. RESULTS: Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement. CONCLUSION: Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents. LEVEL OF EVIDENCE: Therapeutic study, level IV.",
keywords = "Spinal cord injury, albuterol, bradycardia",
author = "Evans, {Charity H.} and Duby, {Jeremiah J.} and Berry, {Andrew J.} and Schermer, {Carol R.} and Cocanour, {Christine S.}",
year = "2014",
month = "2",
day = "1",
doi = "10.1097/TA.0000000000000118",
language = "English (US)",
volume = "76",
pages = "297--302",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia

AU - Evans, Charity H.

AU - Duby, Jeremiah J.

AU - Berry, Andrew J.

AU - Schermer, Carol R.

AU - Cocanour, Christine S.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - BACKGROUND: Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. METHODS: The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered. RESULTS: Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement. CONCLUSION: Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents. LEVEL OF EVIDENCE: Therapeutic study, level IV.

AB - BACKGROUND: Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. METHODS: The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered. RESULTS: Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement. CONCLUSION: Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents. LEVEL OF EVIDENCE: Therapeutic study, level IV.

KW - Spinal cord injury

KW - albuterol

KW - bradycardia

UR - http://www.scopus.com/inward/record.url?scp=84894196538&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894196538&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000118

DO - 10.1097/TA.0000000000000118

M3 - Article

C2 - 24458037

AN - SCOPUS:84894196538

VL - 76

SP - 297

EP - 302

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -