Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

Abstract

Background and AimsThere is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline.Patients and MethodsWe performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay.ResultsA total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively).ConclusionsIn our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before.Trial Registration EudraCT 2009-016042-57

Nebulized hypertonic saline in infants hospitalized with moderately severe bronchiolitis due to RSV infection: A multicenter randomized controlled trial

“…Of the three trials performed using the nebulization protocol of three doses every 2 h, followed by five doses every 4 h in the first 24 h, then every 6 h until discharge, two resulted in a significant shortening of LOS but one did not . While the intervals between nebulization therapy in the other trials that showed a shortened LOS were every 8 h and every 6 h, the intervals in the trials that did not show any shortening of LOS were every 4 h, every 6 h, and every 8 h . The systematic review showed no significant difference in the reduction of LOS between trials that used more frequent saline nebulization .…”

Rational drug use for acute bronchiolitis in emergency care

“…According to a review prepared by Chen et al 21 ; HS significantly decreased both the rate and the duration of hospitalization. A study from Spain has demonstrated that ADR+HS significantly shortens LOS in hospitalized infants with acute moderate bronchiolitis compared to HS 22 . In the study of Miraglia et al 23 ; ADR+HS was found significantly superior to ADR with regard to LOS.…”

Duration of Hospitalization in Association with Type of Inhalation Therapy Used in the Management of Children with Nonsevere, Acute Bronchiolitis

“…Our findings are contrary to those of other reports that show w1-day mean reduction in the duration of hospitalization for children with bronchiolitis using inhaled HS 3,17 or no effect 11e13 of inhaled HS on the LOS. Nevertheless, variability in dosage regimens and cointerventions, 18 as well as no short-term improvement in clinical scores with inclusion of 3% HS in inhaled therapy 19,20 and no additional benefit of adding 3% HS to nebulized solution with bronchodilators, 21 all call into question the beneficial effects of 3% HS. A revised American Academy of Pediatrics clinical practice guideline published in 2014 identified administration of nebulized HS to infants and children hospitalized for bronchiolitis as a weak recommendation due to inconsistent findings.…”