What is a common nebulizer solution for pediatric patients?

Common Nebulizer Solutions for Pediatric Patients

Albuterol (salbutamol) is the most common nebulizer solution used for pediatric patients, typically dosed at 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then every 1-4 hours as needed. 1, 2

First-Line Nebulizer Solutions

• Albuterol (salbutamol) is the primary bronchodilator used in nebulized form for pediatric patients with respiratory conditions, particularly asthma exacerbations 1, 2
• For children weighing at least 15 kg, the standard dose is 2.5 mg administered three to four times daily by nebulization 3
• For children weighing less than 15 kg, a lower concentration solution (0.5%) should be used to deliver the appropriate weight-based dose 3
• The solution should be diluted to a minimum of 3 mL with normal saline for optimal delivery using a flow rate of 6-8 L/min 2

Combination Therapy for Moderate to Severe Cases

• Ipratropium bromide (anticholinergic) can be added to albuterol for children with moderate to severe asthma exacerbations 1, 4
• For children with severe asthma (peak expiratory flow rate <50% of predicted), adding ipratropium significantly reduces hospitalization rates (37.5% vs 52.6% with albuterol alone) 4
• The recommended ipratropium dose is 250-500 μg via nebulizer, typically administered with the second and third doses of albuterol 5, 4
• When using combination therapy (like Duolin), the appropriate dose is 1.5 mL of solution containing 0.25 mg ipratropium bromide and 1.25 mg salbutamol 5

Administration Guidelines

• For acute exacerbations, administer albuterol every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2
• Nebulization should take approximately 5-15 minutes to complete 3
• Masks are preferred for babies and young children when coordination is difficult 1
• Mouthpieces should be used for nebulized steroids to prevent facial deposition and for antibiotics when a filter is needed 1

Alternative Nebulizer Solutions

• Budesonide (Pulmicort) respules - a nebulized steroid that may be used in croup (500 μg) to reduce symptoms in the first two hours 1
• Normal saline (0.9% sodium chloride) - sometimes used to assist with physiotherapy 1
• Ribavirin - may be considered in infants with severe bronchiolitis or those at high risk 1

Important Considerations

• Water should never be used as a diluent as it may cause bronchoconstriction when nebulized 1
• In patients with acute severe asthma, oxygen should be used as the driving gas for nebulization when possible, as these patients are often hypoxic 1
• For children with severe exacerbations, continuous albuterol nebulization may be considered at 0.5 mg/kg/hour 6, 7
• The volume of fluid in the nebulizer chamber is usually 2.0-4.5 mL, with most nebulizers leaving approximately 0.5 mL as residual after nebulization 1

Delivery Devices and Techniques

• For mild to moderate exacerbations, a metered-dose inhaler (MDI) with spacer can be as effective as nebulized therapy with appropriate technique and coaching 1, 2
• The standard MDI dose is 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 6
• Nebulizers are preferred when large drug doses are needed, when coordinated breathing is difficult, or when hand-held inhalers have been ineffective 1
• Proper mask fit is essential for maximizing medication delivery in young children 5