A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis

Super, Dennis M.; Cartelli, Nancy A.; Brooks, Lee J.; Lembo, Robert M.; Kumar, Mary L.

doi:10.1016/s0022-3476(89)80095-2

Cited by 125 publications

(43 citation statements)

References 21 publications

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“…The types and doses of corticosteroids have been sufficiently varied to make the interpretation of results extremely difficult. A similar long-standing debate about the effectiveness of corticosteroid treatment of viral croup was resolved in 1989 when a meta-analysis of all reported clinical trials suggested that the type and dose of corticosteroid were critical factors in determining the outcome (3), a conclusion reinforced by the publication of a well-designed, double-blind, placebo-controlled study which demonstrated a significant benefit from a large dose of dexamethasone (11). In this series of experiments, triamcinolone and methylprednisolone were more effective than dexamethasone and lacked adverse effects; they also reduced pulmonary histopathology in RSV-infected cotton rats by equal amounts.…”

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confidence: 99%

Comparison of Corticosteroids for Treatment of Respiratory Syncytial Virus Bronchiolitis and Pneumonia in Cotton Rats

Ottolini¹,

Curtis²,

Porter

et al. 2002

Antimicrob Agents Chemother

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Triamcinolone acetonide, methylprednisolone, and dexamethasone were each evaluated in combination with palivizumab (Synagis) for the therapy of established respiratory syncytial virus infection in the cotton rat. Triamcinolone and methylprednisolone proved to be more effective than dexamethasone in reducing lung pathology. No recurrence of viral replication or pulmonary pathology followed the cessation of therapy.The cotton rat model of respiratory syncytial virus (RSV) infection has been used for over 20 years to study the pathogenesis and potential therapy of RSV (7). This animal model was invaluable in proving the protective efficacy of anti-RSV antibody (6) and led to the development of RSV immunoglobulin (RespiGam; Medimmune, Inc., Gaithersburg, Md.) and palivizumab (Synagis; Medimmune) for the prevention of severe RSV infection of the lower respiratory tract (1, 2, 5). These preparations have been less effective when used therapeutically (9, 10). Recent experiments with cotton rats demonstrated that combined systemic therapy with palivizumab and triamcinolone acetonide, a potent glucocorticoid, greatly reduced inflammatory changes and viral replication in animals infected with RSV but that palivizumab alone reduced viral titers without altering the degree of inflammation (8). Systemic triamcinolone acetonide is rarely used in the treatment of pediatric respiratory disease, and therefore we examined the comparative efficacies of triamcinolone acetonide, methylprednisolone, and dexamethasone when each was used in combination with palivizumab in the treatment of experimental RSV infection.( Virus. A pool of the prototypic Long strain of RSV (American Type Culture Collection, Manassas, Va.) which contained 10 7.5 PFU/ml was used for all experiments. Pulmonary virus titers were determined by plaque assay as described previously (7).Monoclonal antibody and glucocorticoids. Palivizumab was provided by Medimmune, Inc. Triamcinolone acetonide (Steris Laboratories, Phoenix, Ariz.) was administered as a single daily intramuscular (i.m.) dose of 16 mg/kg of body weight, a dose previously found to be highly effective in reducing pulmonary pathology (8). Dexamethasone (Elkins-Sinn, Cherry Hill, N.J.) was administered in a single daily intraperitoneal (i.p.) dose of 0.6 or 1.2 mg/kg. Methylprednisolone (SoluMedrol; Phamacia and Upjohn, Kalamazoo, Mich.) was administered in a total daily dose of 4 or 8 mg/kg divided into four equal i.p. injections.Histopathology. Lungs were inflated to their normal volume with 10% formalin. Hematoxylin-and eosin-stained slides were prepared from coronal paraffin-embedded sections and scored for peribronchiolitis (inflammatory cells around small airways), interstitial pneumonitis (inflammatory cell infiltration and thickening of alveolar walls), and alveolitis (inflammatory cells within the alveolar spaces). Slides were scored in a blind manner by three investigators using a scale ranging from 0 (no inflammatory changes) to 100 (maximum inflammation).Statistical analysis. A viral titer was...

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confidence: 99%

Comparison of Corticosteroids for Treatment of Respiratory Syncytial Virus Bronchiolitis and Pneumonia in Cotton Rats

Ottolini¹,

Curtis²,

Porter

et al. 2002

Antimicrob Agents Chemother

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“…1). Using the respiratory severity index, which was compiled from existing literature, [14][15][16] 11% of children were characterized as having moderate to high illness severity; 89% were assessed as having no or mild illness severity. Online medical direction was used in 9% of total encounters.…”

Section: Resultsmentioning

confidence: 99%

Use of Out‐of‐hospital Interventions for the Pediatric Patient in an Urban Emergency Medical Services System

Scribano

Baker

Holmes

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: To determine appropriateness of out-of-hospital interventions by emergency medical services (EMS) personnel on children with respiratory illnesses. Methods: A retrospective, cross-sectional study was performed on a random sample of 304 children transported by an urban EMS system during 1994. Data were abstracted from EMScan (a computerized database of all EMS dispatches) and the EMS narrative records. Appropriate utilization of interventions was determined by comparison with the standard EMS protocol for respiratory complaints in this system. An assessment of whether interventions were inappropriately underutilized or inappropriately overutilized was made. Effect of severity of illness, patient age, transport times, and use of medical command on the use of interventions was evaluated. Results: Two hundred three patients (67%) were classified as having respiratory distress. Overall, 56% of the patients received appropriate interventions, 39% received one or two inappropriate interventions, and 5% received three or more inappropriate interventions. Rates of inappropriate utilization with 95% CI for each intervention were: oxygen 16% (95% CI = 12 to 20), assisted ventilation 2% (95% CI = 0.5 to 4), medication use 9% (95% CI = 6 to 13), vascular access 11% (95% CI = 7 to 14), phlebotomy 9% (95% CI = 6 to 13), and cardiac monitoring 18% (95% CI = 14 to 22). Oxygen and medications were underutilized (p < 0.005), whereas vascular access, cardiac monitoring, and phlebotomy were overutilized (p < 0.005). Online medical command (used in 9% of transports) improved appropriate use of vascular access [OR 8.3 (95% CI = 3 to 25) (p < 0.001)] and cardiac monitoring [OR = 3 (95% CI = 1 to 8) (p < 0.05)]. Conclusions: Emergency medical services personnel underutilized oxygen and medications and overutilized vascular access, phlebotomy, and cardiac monitoring in children with respiratory illness in this urban setting. Increasing patient age, transport times, and illness severity tend to increase the use of certain interventions, while contact with online medical direction seems to improve appropriate use of interventions.

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“…Twelve items (level of consciousness or mental status, inspiratory breath sounds, air entry, stridor, cough, cyanosis or colour, anxiety or air hunger, retractions and/or flaring, respiratory rate and heart rate, oxygen saturation and respiratory distress) were identified from 10 croup scoring instruments (6,(8)(9)(10)(11)(12)(13)(14)(15)(16) (Table 1). Five other scoring instruments modified single items in a previously published score (17)(18)(19). Responses to items, with the exception of two categorical variables (13), were ordinal in nature, and were scored between 0 and 3.…”

Section: Item Identificationmentioning

confidence: 99%

Interobserver variability of croup scoring in clinical practice

Chan

Langley

LeBlanc

2001

Paediatrics &Amp; Child Health

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BACKGROUND: Viral laryngotracheobronchitis croup is the most common cause of acute upper airway obstruction in young children. Clinical assessment of children with croup is often performed using 'croup scores'; however, these scores have not been validated outside of the research setting. OBJECTIVE: To determine the reliability of clinical observation items in croup scores in a paediatric emergency department (ED) setting. DESIGN: Literature review identified 12 observation items (level of consciousness or mental status, inspiratory breath sounds, air entry, stridor, cough, cyanosis or colour, anxiety or air hunger, retractions and/or flaring, respiratory rate and heart rate, oxygen saturation and respiratory distress); overlapping items were combined, yielding 10 variables. In a prospective cohort study over 13 months, patients presenting with croup were observed independently, and croup scores were assigned by the triage nurse, ED nurse and the ED physician before treatment. Agreement among observers for clinical observations was analysed using Cohen's quadratic weighted kappa. SETTING: University-affiliated, paediatric hospital ED providing primary care to an urban area (population 330,000). PATIENTS: Children aged three months to five years presenting with viral croup (preceding history of at least one day of upper respiratory tract symptoms associated with barking cough and/or hoarseness and/or stridor). RESULTS: One hundred fifty-eight children meeting inclusion criteria for croup were assessed by three observers within 1 h of each other's assesments and before treatment. Interobserver agreement among the three observers using weighted kappa was greater than chance for all clinical observation items and ranged from fair to moderate (0.2 to 0.4 and 0.4 to 0.6, respectively). CONCLUSIONS: In the busy practice setting of a paediatric ED, substantial interobserver variability exists among health care providers in the measurement of respiratory signs associated with croup in young children. Based on the present study in a practice setting and two research

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A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis

Cited by 125 publications

References 21 publications

Comparison of Corticosteroids for Treatment of Respiratory Syncytial Virus Bronchiolitis and Pneumonia in Cotton Rats

Comparison of Corticosteroids for Treatment of Respiratory Syncytial Virus Bronchiolitis and Pneumonia in Cotton Rats

Use of Out‐of‐hospital Interventions for the Pediatric Patient in an Urban Emergency Medical Services System

Interobserver variability of croup scoring in clinical practice

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