A Multicenter, Randomized, Double-Blind, Controlled Trial of Nebulized Epinephrine in Infants with Acute Bronchiolitis

Wainwright, Claire; Altamirano, Luis; Cheney, Marise; Cheney, Joyce; Barber, Scott; Price, D A; Moloney, Susan; Kimberley, A. P. S.; Woolfield, Nick; Cadzow, Susan; Fiumara, Frank; Wilson, P; Mego, Steve; VandeVelde, Dianne; Sanders, Sharon; O’Rourke, Peter; Francis, Paul S.

doi:10.1056/nejmoa022226

Cited by 210 publications

(148 citation statements)

References 20 publications

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“…nebulization with 4 ml of adrenaline (1:1000) in children with bronchiolitis. 17 These increases were not, however, statistically significant (p values: 0.06 and 0.83). Waisman et al also failed to detect significant effects on the systemic arterial pressure of children with laryngotracheobronchitis after nebulization with 5 ml of adrenaline (1:1000).…”

Section: Menon Et Al Patientsmentioning

confidence: 84%

“…Five trials evaluated the effects of adrenaline on bronchiolitis, 4,[17][18][19][20] and two on laryngotracheobronchitis. 10,11 Table 1 shows the characteristics of the seven clinical trials.…”

Section: Resultsmentioning

confidence: 99%

“…Two of the five trials that used adrenaline doses greater than or equal to 3 ml 4,10,11,17,19 demonstrated a significant increase in heart rate. 17,4 In the first study, 99 children admitted for bronchiolitis were given three consecutive nebulizations with 4 ml of adrenaline (1:1000), at 4-hour intervals. 17 The average increase in heart rate, compared with the base rate prior to nebulization, was 13 to 21 beats per minute (bpm), 30 minutes after each nebulization, and 10 to 15 bpm 60 minutes after each nebulization.…”

Section: The Effects Of Inhaled Adrenaline On Heart Ratementioning

confidence: 99%

“…17,4 In the first study, 99 children admitted for bronchiolitis were given three consecutive nebulizations with 4 ml of adrenaline (1:1000), at 4-hour intervals. 17 The average increase in heart rate, compared with the base rate prior to nebulization, was 13 to 21 beats per minute (bpm), 30 minutes after each nebulization, and 10 to 15 bpm 60 minutes after each nebulization. These increases were statistically significant, compared with a control group (nebulization with saline) (p values between 0.02 and < 0.001).…”

Section: The Effects Of Inhaled Adrenaline On Heart Ratementioning

confidence: 99%

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Segurança de nebulização com 3 a 5 ml de adrenalina (1:1000) em crianças: uma revisão baseada em evidência

Zhang¹,

Sanguebsche²

2005

J. Pediatr. (Rio J.)

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Suggested citation: Zhang L, Sanguebsche LS. The safety of nebulization with 3 to 5 ml of adrenaline (1:1000) in children: an evidence based review. J Pediatr (Rio J). 2005;81:193-7. AbstractObjective: To present the evidence regarding the safety of nebulization with 3-5 ml of adrenaline (1:1000) for the treatment of children with acute inflammatory airway obstruction.Sources of data: An electronic search was undertaken, using mainly Medline databases (January of 1949-July of 2004). The study inclusion criteria for this review were: 1) randomized clinical trial; 2) Patients (up to 12 yrs) with diagnosis of bronchiolitis or laryngotracheobronchitis; 3) use of adrenaline (1:1000) by nebulization. The principal data extracted from the trials included adrenaline dosages and their effects on heart rate and blood pressure and any other side effects.Summary of the findings: Seven clinical trials with a total of 238 patients were included for this review. Two of the five trials in which larger dosages (> 3 ml) of adrenaline were used demonstrated a significant increase in heart rate. The mean increase in heart rate varied from seven to 21 beats per minute, up to 60 minutes after treatment. The highest incidence of pallor was observed in one trial with 21 children treated by nebulization with 3 ml of adrenaline (47.6% in the adrenaline group vs. 14.3% in the salbutamol group, 30 minutes after treatment). Two clinical trials failed to observe a significant effect on blood pressure from nebulization with adrenaline (4 and 5 ml). Conclusion:Evidence shows that nebulization with 3 to 5 ml of adrenaline (1:1000) is a safe therapy, with minor side-effects, for children with acute inflammatory airway obstruction.J Pediatr (Rio J). 2005;81(3):193-7: Adrenaline, nebulization, laryngotracheobronchitis, bronchiolitis, side effects.

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Section: Menon Et Al Patientsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: The Effects Of Inhaled Adrenaline On Heart Ratementioning

confidence: 99%

Section: The Effects Of Inhaled Adrenaline On Heart Ratementioning

confidence: 99%

See 2 more Smart Citations

Segurança de nebulização com 3 a 5 ml de adrenalina (1:1000) em crianças: uma revisão baseada em evidência

Zhang¹,

Sanguebsche²

2005

J. Pediatr. (Rio J.)

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“…The evidence from Wainwright et al's study (4), supports the use of epinephrine in treating outpatients, but not inpatients with bronchiolitis. However, the review had several limitations.…”

mentioning

confidence: 93%

In infants with bronchiolitis, is epinephrine more effective than placebo in improving clinical outcomes, as measured by clinical score, oxygen saturation and respiratory rate?

Aerde

2003

Paediatrics &Amp; Child Health

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E pinephrine is a combined alpha-adrenergic and betaadrenergic agonist (1). It has been hypothesized that epinephrine would be effective in the treatment of bronchiolitis by causing bronchodilation and by reducing tissue edema via vasoconstriction in the bronchiolar vasculature. The current literature suggests that epinephrine may be effective in the treatment of bronchiolitis for outpatients but not inpatients (grade of recommendation: A, based on a systematic review).Hartling and colleagues (2) completed a systematic review studying the effect of epinephrine on infants with bronchiolitis. The review included only randomized controlled trials, the highest level of evidence for therapy questions (3). Fourteen trials met the inclusion criteria, three of which compared epinephrine with placebo among outpatients. The results indicated that epinephrine was favourable to placebo for short-term benefits among outpatients. In particular, the change in clinical score, determined by measuring various clinical features of bronchiolitis, at 60 min post-treatment (standardized mean difference [SMD] -0.8, 95% CI -1.6 to -0.07), the change in oxygen saturation at 30 min post-treatment (WMD 2.8, 95% CI 1.5 to 4.1), the respiratory rate at 30 min post-treatment (weighted mean difference [WMD] -4.5, 95% CI -8.9 to -0.2) and 'improvement' (OR 25.1, 95% CI 5.0 to 127) as defined within the individual studies, all favoured epinephrine. However, there was no significant difference between epinephrine and placebo on admission rates (OR 0.51, 95% CI 0.18 to 1.42), change in clinical score at 30 min post-treatment (SMD -0.55, 95% CI -1.11 to 0.02) or change in oxygen saturation at 60 min posttreatment (WMD 1.20, 95% CI -0.13 to 2.53). Yet, in terms of the overall clinical picture, epinephrine is more effective than placebo in the outpatient population for the treatment of bronchiolitis.For inpatients, there were no group differences in the effectiveness of therapy. Hartling et al (2) included five inpatient randomized controlled studies in their review.They found no significant differences between epinephrine and placebo, except for a change in clinical score at 60 min (SMD -0.5, 95% CI -1.0 to -0.03). One of the randomized controlled studies included in the review deserves particular attention. Wainwright et al (4) conducted a randomized, double-blind, controlled trial comparing nebulized singleisomer epinephrine with placebo in 194 infants. The primary outcomes were length of hospital stay and time until the infant was ready for discharge. The study was of good methodological quality with a Jadad score of four (a score of less than three indicates a poor quality study and a score of five indicates maximum quality) (5). The analysis had a power of 85%, meaning there was an 85% chance of detecting a significant effect, and indicated that treatment with epinephrine had no effect on time in hospital or time until discharge. Also, there were no significant changes in the respiratory rate, blood pressure or respiratory-effort scores after ...

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A Meta-analysis of Randomized Controlled Trials Evaluating the Efficacy of Epinephrine for the Treatment of Acute Viral Bronchiolitis

Hartling¹,

Wiebe²,

Russell³

et al. 2003

Arch Pediatr Adolesc Med

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A Multicenter, Randomized, Double-Blind, Controlled Trial of Nebulized Epinephrine in Infants with Acute Bronchiolitis

Abstract: The use of nebulized epinephrine did not significantly reduce the length of the hospital stay or the time until the infant was ready for discharge among infants admitted to the hospital with bronchiolitis.

Cited by 210 publications

References 20 publications

Segurança de nebulização com 3 a 5 ml de adrenalina (1:1000) em crianças: uma revisão baseada em evidência

Segurança de nebulização com 3 a 5 ml de adrenalina (1:1000) em crianças: uma revisão baseada em evidência

In infants with bronchiolitis, is epinephrine more effective than placebo in improving clinical outcomes, as measured by clinical score, oxygen saturation and respiratory rate?

A Meta-analysis of Randomized Controlled Trials Evaluating the Efficacy of Epinephrine for the Treatment of Acute Viral Bronchiolitis

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