A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis.
OBJECTIVE
In previously well infants hospitalized with acute viral bronchiolitis, the effectiveness of repeated nebulized therapy with epinephrine (EPI) was compared with treatment with albuterol (ALB) or saline placebo (PLAC).


METHODS
In this randomized, double-blind, parallel-group, controlled trial, infants received study nebulizations every 1 to 6 hours and were assessed twice daily by the research team. The primary outcome was length of hospital stay (LOS). Secondary outcomes included the time from admission until the infant had normal hydration, oxygenation, and minimal respiratory distress.


RESULTS
A total of 149 infants were randomized; 50 were allocated to receive racemic EPI, 51 were given ALB, and 48 received PLAC. Baseline characteristics and pre-enrollment symptoms, signs, and therapy were similar between groups. There were no group differences in the primary outcome measure, mean LOS (hours)(+/- SD): EPI = 59.8 (62), ALB = 61.4 (54), and PLAC = 63.3 (47); P =.95 by intent-to-treat analysis. Group differences were not statistically significant in any of the secondary outcomes.


CONCLUSIONS
There were no group differences in the effectiveness of therapy for infants hospitalized with bronchiolitis. Based on these results, we do not recommend routine use of either nebulized EPI or ALB in this patient group.
Patel
Hema
H
Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada. hema.patel@muhc.mcgill.ca
Platt
Robert W
RW
Pekeles
Gary S
GS
Ducharme
Francine M
FM
D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D001990:Bronchiolitis, Viral / Q000188:drug therapy*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D009330:Nebulizers and Vaporizers; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000318:Adrenergic beta-Agonists; D000336:Aerosols; D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D000420:Albuterol; D004837:Epinephrine