Arterial Oxygen Desaturation after Salbutamol Nebulization in Wheezy Infants and Children

Yoo, Eun Sun; Seo, Jung Wan; Lee, Seung Joo

Abstract

PURPOSE
Nebulized selective beta2-adrenoreceptor agonists have been widely used in acute asthma and selectively in acute bronchiolitis. However, nebulized salbutamol have been reported to cause arterial oxygen desaturation in some of the acute bronchiolitis and severe asthma patients. This may be the results of a paradoxical bronchoconstriction linked to acidic and hyper-osmolar nebulized salbutamol solution and etc. We assessed the changes in arterial oxygen saturation by percutaneous pulse oxymeter during and after nebulization of salbutamol solution and compared the effect of 100% oxygen with the compressed air as a driving gas.
METHODS
This study was performed in 80 mild to moderate wheezy children(bronchiolitis 51, asthma 29) who were admitted to Pediatrics department of of EWHA from January 1992 to October 1993. The study children are randomly assigned to be nebulized by compressed air or 6l/min of 100% oxygen as a driving gas. The arterial oxygen saturation, wheeze score, retraction score, and heart rate were recorded before nebulization, post-nebulization, 5, 10, 15 and 30minutes.
RESULTS
1) Arterial oxygen saturation decreased significantly at post-nebulization five minutes only in bronchiolitis, treated with salbutamol nebulization without oxygen(p<0.01). Salbutamol nebulization, with oxygen (6l/min) has not changed arterial oxygen saturation both in bronchiolitis and asthma(p>0.05). 2) Wheeze score decreased significantly at post-nebulization 5-30minutes in asthma but not in bronchiolitis whether nebulized salbutamol with or without oxygen(p<0.05). 3) Retraction score increased significantly at post-nebulization 0-5minutes or unchanged in bronchiolitis but significantly decreased in asthma at 10-30minutes(p<0.05). 4) There were no significant change in heart rate and respiratory rate in both groups(p>0.05).
CONCLUSIONS
Significant fall in arterial oxygen saturation was noted only in bronchiolitis treated with salbutamol nebulization without oxygen. In bronchiolitis, oxygen (6l/min) is better than compressed air as a driving gas during salbutamol nebulization to prevent hypoxemia.