A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis☆,☆☆,★,★★
Section snippets
Study setting
The Children's Hospital of Eastern Ontario is a regional tertiary care pediatric hospital. Each year approximately 50,000 patients visit the emergency department, which is staffed 24 hours a day by 10 full-time emergency pediatricians. These pediatricians also care for patients in a holding unit, where children's care is managed awaiting hospitalization or improvement to the point of being discharged home.
Selection of patients
Patients who came to the emergency department between Jan. 1, 1994, and March 30, 1994,
Patient characteristics
During the study period, 81 patients were seen in our emergency department and met the eligibility criteria of our study. Of these, four were seen when the study team was not on call; for 33 patients the emergency physicians failed to contact the study team. Of the 44 parents of patients approached for study participation, 42 agreed to participate.
Twenty-one patients were randomly assigned to the epinephrine group and 21 to the salbutamol group. However, it was discovered after randomization
DISCUSSION
This randomized, controlled trial has shown that nebulized epinephrine causes increased clinical benefit compared with salbutamol in the treatment of acute bronchiolitis in infancy. This benefit is reflected primarily in the markedly reduced admission rates but is also supported by the improved oxygen saturation at 60 minutes, a lower heart rate at 90 minutes, and a faster rate of discharge from the emergency department. These findings are consistent with the findings of Sanchez et al.,12 who
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Randomized trial of salbutamol in acute bronchiolitis
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Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis
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The efficacy of nebulized metaproterenol in wheezing infants and young children
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Bronchodilators for bronchiolitis?
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Effect of salbutamol on oxygen saturation in bronchiolitis
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Cited by (159)
Systematic review of instruments aimed at evaluating the severity of bronchiolitis
2018, Paediatric Respiratory ReviewsSystematic review: Insufficient validation of clinical scores for the assessment of acute dyspnoea in wheezing children
2014, Paediatric Respiratory ReviewsCitation Excerpt :AS Asthma score; [13] ASS asthma severity score; [14–19] BS bronchiolitis score (original names: BS-2 respiratory scale; BS-3 clinical scoring; BS-4 severity score); [20–23] CAES clinical asthma evaluation score (original names: CAES-2 clinical severity score or modified clinical asthma score; CAES-3 modified clinical asthma score); [24–27] CAS clinical asthma score [28]; CS clinical score [29]; CSGS clinical symptom grading system; [30,31] CSS clinical scoring system (original names: CSS-2 modified Tal's clinical score; CSS-4 clinical score); [6,32–41] EDRAR escala de diffcultad respiratoria de la Argentina; [42] EDRCH escala de dificultad respiratoria de Chile;41 MPIS modified pulmonary index score; [43] PASS pediatric asthma severity score; [44,45] PRAM paediatric or preschool respiratory assessment measure; [45–47] PIS pulmonary index score; [48–54] PS pulmonary score; [45,46] RA respiratory assessment; [57] RAD respiratory rate – accessory muscle use – decreased breath sounds; [45] RDAI respiratory distress assessment instrument; [58–67] RDI respiratory distress index; [68,69] SS severity score; [70] SOIS severity of illness score [71].
Bronchiolitis
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth EditionComparision of nebulised salbutamol and L-epinephrine in first time wheezy children
2010, Medical Journal Armed Forces IndiaCitation Excerpt :Analysis of the results showed a significant improvement in respiratory status (RR, RDAI, SpO2 and Rint) with both epinephrine and salbutamol with the benefit more marked in the epinephrine group. Unlike other studies [1,18], this study did not see any significant difference in increase in heart rate in the two groups while there was a significant short term rise in HR in both groups after the intervention. There were no side effects of the bronchodilators used during the study which was similar to what was observed by other workers including those that did not find any benefit with the bronchodilators [1,19,20].
NONBACTERIAL PNEUMONIA
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition
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From the Department of Pediatrics, University of Ottawa, and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Supported by grant No. R93-47 from the Physicians Services Incorporated Foundation.
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Reprint requests: Terry P. Klassen, MD, Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa, Ontario, K1H 8L1, Canada
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