Levalbuterol Isn't More Beneficial Than Albuterol in Critically Ill Patients

Over the years, some clinicians have worried that inhaled beta-agonists (e.g., albuterol) are linked to adverse cardiac events in critically ill patients. Levalbuterol, the R-isomer of albuterol, has been marketed as an alternative with fewer side effects than standard racemic albuterol. However, differences between these two medications have not been assessed in critically ill patients.

Investigators studied 70 patients in the intensive care unit (half of whom were receiving mechanical ventilation) who were given nebulized bronchodilators every 4 to 6 hours. In addition to receiving the anticholinergic ipratropium, patients were randomized to receive alternating doses of albuterol and levalbuterol, beginning with one or the other drug. Mean…