473 - Noninvasive Respiratory Support for Pediatric Critical Asthma and Urine Albuterol Levels: A Prospective Cohort Study

Publication Number: 473.5838

Brett W. Russi, USF Health Morsani College of Medicine, Saint Petersburg, FL, United States; Alexa R. Roberts, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Steven Bruzek, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Vera Ignjatovic, Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, FL, United States; Kristina K. Darville, Johns Hopkins All Children's Hospital, Tampa, FL, United States; Neil Goldenberg, Johns Hopkins University School of Medicine, St. Petersburg, FL, United States; Peter Thomas. Scully, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States; Anthony A. Sochet, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States

Background: Continuous nebulized albuterol is a key component of pediatric critical asthma management. A variety of noninvasive respiratory support (NRS) interfaces are used to deliver continuous albuterol without evidence to suggest superiority.

Objective: To characterize and compare urine albuterol levels (uAlb) among children with critical asthma receiving continuous albuterol via bilevel positive airway pressure (BiPAP), high-flow nasal cannula (HFNC), and simple mask (SM) interfaces.

Design/Methods: We performed a prospective cohort study of children 3-17 years of age hospitalized for critical asthma from Nov 2023 – Oct 2024 receiving continuous albuterol. Along with demographics, anthropometrics, asthma-related history, inpatient treatment, and outcomes data, uAlb concentrations (assessed via ELISA and corrected for urinary creatinine) were compared by NRS cohorts using descriptive and comparative statistics.

Results: Of 55 children studied during an interim analysis, continuous albuterol was administered to 18 (32.7%) via BiPAP, 3 (5.5%) via HFNC, and 34 (61.8%) via SM. For the BiPAP group, mean inspiratory PAP was 13.4±2.6 cmH2O and expiratory PAP was 6.9±1.4 cmH2O. For the HFNC group, mean flow rate was 10.7±3.1 L/min. Mean uAlb was significantly lower (p=0.005) among those receiving BiPAP (0.24±0.12 µg:mL/mg:dL) as compared to SM (0.31±0.19 µg:mL/mg:dL) and HFNC (0.39±0.44 µg:mL/mg:dL). No differences were detected among the NRS-interface cohorts (BiPAP, HFNC, and SM) in regard to age, weight, demographics, National Heart Lung and Blood Institute chronic asthma severity, admission Pediatric Asthma Severity Score, frequency of adjunct asthma interventions (i.e., ketamine, terbutaline, aminophylline, magnesium, epinephrine, and heliox), systemic corticosteroids, mean albuterol dose (15.1±4.2 mg vs 13.3±2.9 mg vs 16.7±3.8 mg), mean continuous albuterol duration (1.8±1.2 days vs 0.9±0.6 days vs 1.1±0.9 days), mean length of stay (4.4±2.1 days vs 2.5±0.7 days vs 2.6±1.9 days), or frequency of mortality, pneumothorax, or invasive ventilation.

Conclusion(s): In this prospective cohort study of children with critical asthma characterizing uAlb levels by NRS interface, we detected significantly lower uAlb levels for those on BiPAP as compared to SM and HFNC despite no differences in albuterol dosing or other clinical parameters. Future research should evaluate for association between uAlb and albuterol airway deposition and whether uAlb varies by NRS parameters.