Adrenaline administered via a nebulizer in adult patients with upper airway obstruction

Macdonnell, S. P. J.; Timmins, Andrew C.; Watson, Joe

doi:10.1111/j.1365-2044.1995.tb04510.x

Cited by 39 publications

(22 citation statements)

References 7 publications

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“…Likewise, there is no consensus about the potentially effective dosage of epinephrine nebulization. A dose of 1 mg epinephrine in 5 ml normal saline has proved successful in some cases of upper airway obstruction in adults [51]. Rebound edema is known to occur and close observation is essential [52].…”

Section: Therapymentioning

confidence: 99%

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

et al. 2009

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Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.

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Section: Therapymentioning

confidence: 99%

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

et al. 2009

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“…Nebulised adrenaline is a well recognized treatment for upper airways obstruction caused by croup (acute laryngotracheobronchitis) and post intubation oedema 1 . Here we describe what we believe to be the first reported case of the effectiveness of nebulised adrenaline in the treatment of upper airways obstruction occurring secondary to the ingestion of a caustic substance.…”

mentioning

confidence: 81%

Upper Airway Obstruction Induced by a Caustic Substance Found Responsive to Nebulised Adrenaline

Ziegler

Bent

2001

J Paediatrics Child Health

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The early diagnosis of sepsis during the newborn period is an important problem because the early signs and symptoms of septicemia in term or preterm infants are usually nonspecific. 1,2 Examination of buffy coat smears stained with Gram, methylene blue or acridine orange (AO) stains or an acridine orange leukocyte cytospin (AOLC) test have been used as a rapid test for bacteremia. 2,3 However, studies evaluating AO-stained smears in detecting neonatal sepsis are scarce. [1][2][3][4] In this present study, blood culture was accepted as gold standard, and the results of concentrated blood smears stained with AO and Gram stain were compared. Our purpose was to determine whether the AOLC test is useful for further consideration in the diagnosis of neonatal sepsis.The study group consisted of 24 infants had a diagnosis of sepsis in Erciyes University, Faculty of Medicine Department of Pediatrics, Kayseri, Turkey. Physical examination, routine blood and urine analyses, sedimentation rate, C-reactive protein (CRP) assays, blood culture analysis and cerebrospinal fluid examination were performed in all infants. The blood smears prepared with cytospin centrifuge method were stained with Gram and AO. When two or more microorganisms were observed in the smear, it was accepted as positive. Of the 24 infants, nine (37.5%) were boys, 15 (62.5%) were girls and the age ranged from 12 h to 30 days (mean 10.89 ± 8.45 days). In 12 (50%) patients, various microorganisms were cultured from blood; enterococci, 3 Klebsiella pneumonia, 2 Escherichia coli, 2 coagulase-negative Staphylococci, 1 Staphylococcus epidermidis, 1 Group A beta hemolytic streptococci, 1 enterocbacter 1 and non-fermentative bacterium. 1 While bacteria were observed in 11 (91%) of 12 samples, which were prepared concentrated and stained with AO staining in the patients who were blood culture positive, bacteria were observed in two of the patients who were blood culture negative. While bacteria were observed in four (33.3%) of 12 samples, which were prepared concentrated and stained using a Gram stain, they were observed in two (16.6%) of the patients who were blood culture negative. While serum CRP was high in 11 (91%) of the patients who were blood culture positive, it was high in seven (58%) of the patients who were blood culture negative. White blood cell count was abnormal in nine (75%) and seven (58%) of the patients who were blood culture positive and negative, respectively. A shift to the left was reported in nine (75%) and eight (66%) of the patients who were blood culture positive and negative, respectively. The sensitivities of the AOLC test, Gram staining test, CRP assay, white blood cell count and shift to the left were found to be 91%, 50%, 91%, 75% and 75%, respectively. The specificities of the AOLC test, Gram staining test, CRP assay, white blood cell count and shift to the left were found to be 84%, 83%, 41%, 41% and 33%, respectively. Although the sensitivity of AOLC and CRP tests was found to be similar, the specificity of AOLC test was higher ...

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“…Similar effects with the α 1 agonist, phenylephrine have been demonstrated to reduce nasal oedema in anaesthetised horses when applied intranasally (Lukasik et al 1997). Nebulised adrenaline has been suggested to reduce oedema in laryngotracheobronchitis and in postintubation laryngeal oedema in children (Adair et al 1971, Bjornson et al 2013 and also in adults with oedema causing upper airway obstruction (MacDonnell et al 1995). Nebulisation offered a means of topical application as the dog would not tolerate handling of the tongue.…”

Section: Case Historymentioning

confidence: 96%

Nebulised adrenaline to manage a life‐threatening complication in a pug with trismus

Leece¹,

Cherubini²

2015

J of Small Animal Practice

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A 13-month-old pug with severe trismus because of suspected masticatory muscle myositis underwent anaesthesia for magnetic resonance imaging. When regurgitation occurred, the tongue was pulled from the mouth to enable suctioning but could not be repositioned into the oral cavity as it was not possible to open the mouth. Swelling due to venous congestion and a bite wound were treated using nebulised adrenaline and resolved within 2 hours allowing retraction of the tongue. The use of nebulised adrenaline offers a non-invasive method of managing this potentially life-threatening complication.

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Adrenaline administered via a nebulizer in adult patients with upper airway obstruction

Cited by 39 publications

References 7 publications

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Upper Airway Obstruction Induced by a Caustic Substance Found Responsive to Nebulised Adrenaline

Nebulised adrenaline to manage a life‐threatening complication in a pug with trismus

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