Comparison of nebulized epinephrine to albuterol in bronchiolitis

Paul Walsh, John Caldwell, Kemedy K McQuillan, Steven Friese, Dale Robbins, Stephen J Rothenberg, Paul Walsh, John Caldwell, Kemedy K McQuillan, Steven Friese, Dale Robbins, Stephen J Rothenberg

Abstract

Objectives: To compare the effect of nebulized racemic epinephrine to nebulized racemic albuterol on successful discharge from the emergency department (ED).

Methods: Children up to their 18th month of life presenting to two teaching hospital EDs with a clinical diagnosis of bronchiolitis who were ill enough to warrant treatment but did not need immediate intubation were eligible for this double-blind randomized controlled trial (RCT). Patients received either three doses of racemic albuterol or one dose of racemic epinephrine plus two saline nebulizers. Disposition was decided 2 hours after the first nebulizer. Successful discharge was defined as not requiring additional bronchodilators in the ED after study drug administration and not subsequently admitted within 72 hours. Adjusted relative risks (aRR) were estimated using the modified Poisson regression with successful discharge as the dependent variable and study drug and severity of illness as exposures. Secondary analysis was performed for patients aged less than 12 months and first presentation.

Results: The authors analyzed 703 patients; 352 patients were given albuterol and 351 epinephrine. A total of 173 in the albuterol group and 160 in the epinephrine group were successfully discharged (crude RR = 1.08, 95% confidence interval [CI] = 0.92 to 1.26). When adjusted for severity of illness, patients who received albuterol were significantly more likely than patients receiving epinephrine to be successfully discharged (aRR = 1.18, 95% CI = 1.02 to 1.36). This was also true among those with first presentation and in those less than 12 months of age.

Conclusions: In children up to the 18th month of life, ED treatment of bronchiolitis with nebulized racemic albuterol led to more successful discharges than nebulized epinephrine.

Trial registration: ClinicalTrials.gov NCT00114478.

Figures

Figure 1
Figure 1
Ordinal regression model. Reprinted, with permission, from Walsh P, Rothenberg SJ, O'Doherty S, Hoey H, Healy R. A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis. Eur J Emerg Med. 2004; 11(5):265–72. HR = heart rate.
Figure 2
Figure 2
Admission criteria.
Figure 3
Figure 3
Consort diagram.
Figure 4
Figure 4
Age distribution of the study patients.
Figure 5
Figure 5
Numbers successfully discharged and admitted. ED = emergency department.
Figure 6
Figure 6
Summary of results. Successful discharge by severity of illness. Alb = albuterol; Epi = epinephrine.

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