ALTERATIONS IN MYOCARDIAL-SPECIFIC CREATINE-PHOSPHOKINASE IN CHILDRENWITH SEVERE REACTIVE AIRWAY DISEASE TREATED WITH INTRAVENOUS ISOPROTERENOL

Objective: To describe the pattern of alterations in creatine phosphok inase (CPK) and creatine phosphokinase-myocardial isoenzyme (CPK-mb) l evels and electrocardiogram (EGG) changes in children treated with int ravenous infusion of isoproterenol, as determined by elevation of CPK- mb levels/indices and/or ischemic ECG changes. Design: Prospective obs ervational study. Setting: A pediatric intensive care unit of a univer sity teaching hospital. Subjects: Twenty-two critically ill children ( age: 3 months-17 years) with severe reactive airway disease who requir ed intravenous isoproterenol. Interventions: None. Measurements and Ma in Results: Twenty-two children with severe reactive airway disease [p H 7.25 (7.01-7.54), Paco(2) 55 (23-113), and Pao(2) 92 (54-361)] were enrolled in the study. Baseline ECGs prior to intravenous isoprotereno l were unremarkable. Baseline CPK-mb levels/indices were found to be a bnormally elevated in 5 children prior to intravenous isoproterenol. F our of these children manifested a decrease in CPK-mb levels/indices w hile on isoproterenol infusion. Seventeen of 22 children had normal CP K-mb levels/indices prior to isoproterenol infusion. Only 4 of these c hildren experienced abnormal elevations during intravenous isoproteren ol. CPK-mb levels/indices returned to normal in all children within 6 h of discontinuation of intravenous isoproterenol. No dysrhythmias or deaths were noted in patients who received intravenous isoproterenol. Conclusion: Intravenous isoproterenol is an appropriate therapeutic mo dality for children with severe reactive airway disease unresponsive t o conventional therapy.