A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis,☆☆,,★★

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Abstract

This randomized, double-blind trial compared the efficacy of nebulized epinephrine with salbutamol in the treatment of infants with acute bronchiolitis. The mean percent oxygen saturation at 60 minutes was significantly higher in the epinephrine group. Thirty-three percent of the patients in epinephrine group were admitted to the hospital compared with 81% of the salbutamol group (p = 0.003). We conclude that nebulized epinephrine is more efficacious than salbutamol for infants with acute bronchiolitis seen in an emergency department. (J PEDIATR 1995;126:1004-7)

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

References (13)

There are more references available in the full text version of this article.

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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.

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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0022-3476/95/$3.00 + 0 9/26/61904

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