INTRODUCTION: Bronchospasm requiring continuous inhaled albuterol is a common reason for pediatric intensive care unit (PICU) admission. Albuterol's racemic composition may contribute to adverse effects; therefore, levalbuterol [(R)-albuterol] may be used. This study aimed to determine if continuous inhaled levalbuterol is associated with a shorter duration of continuous inhaled bronchodilator therapy and less tachycardia compared to albuterol in PICU patients. METHODS: This study utilized two periods of exclusive continuous inhaled levalbuterol use due to an albuterol shortage. PICU encounters receiving ≥ 12 h of continuous inhaled levalbuterol during those periods were compared to encounters receiving albuterol in the interim. Therapy duration and % change in median heart rate (HR) at 6-h epochs were compared between groups, and multilevel mixed effects models were created. RESULTS: In 686 encounters, there was no difference in therapy duration between levalbuterol and albuterol groups (31.3 vs. 28.7 h, p = 0.22). There was no difference in % change in median HR at 6 (-1.0% vs. -1.3%, p = 0.54), 12 (-1.6% vs. -2.7%, p = 0.28), or 18 h (-2.5% vs. -4.1%, p = 0.38) from therapy initiation. Levalbuterol was not associated with therapy duration adjusting for age, technology dependence, respiratory rate category, and number of continuous intravenous bronchodilators (p = 0.13). Levalbuterol was not associated with % change in median HR at 12 h following therapy initiation after adjusting for age and respiratory rate category (p = 0.99). CONCLUSION: Continuous inhaled levalbuterol was not associated with shorter therapy duration or lower HR compared to albuterol in PICU patients.