A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis.
BACKGROUND
The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and have examined only short-term outcomes, such as clinical scores.


METHODS
We conducted a randomized, double-blind, controlled trial comparing nebulized single-isomer epinephrine with placebo in 194 infants admitted to four hospitals in Queens-land, Australia, with a clinical diagnosis of bronchiolitis. Three 4-ml doses of 1 percent nebulized epinephrine or three 4-ml doses of normal saline were administered at four-hour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after, and 60 minutes after each dose. The primary outcome measures were the length of the hospital stay and the time until the infant was ready for discharge. The secondary outcome measures were the degree of change in the respiratory rate, the heart rate, and the respiratory-effort score and the time that supplemental oxygen was required.


RESULTS
There were no significant overall differences between the groups in the length of the hospital stay (P=0.16) or the time until the infant was ready for discharge (P=0.86). Among infants who required supplemental oxygen and intravenous fluids, the time until the infant was ready for discharge was significantly longer in the epinephrine group than in the placebo group (P=0.02). The need for supplemental oxygen at admission had the greatest influence on the score for severity of illness and strongly predicted the length of the hospital stay and the time until the infant was ready for discharge (P<0.001). There were no significant changes in the respiratory rate, blood pressure, or respiratory-effort scores from before each treatment to after each treatment. The heart rate was significantly increased after each treatment with epinephrine (P=0.02 to P<0.001).


CONCLUSIONS
The use of nebulized epinephrine did not significantly reduce the length of the hospital stay or the time until the infant was ready for discharge among infants admitted to the hospital with bronchiolitis.
Wainwright
Claire
C
Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia. claire_wainwright@health.qld.gov.au
Altamirano
Luis
L
Cheney
Marise
M
Cheney
Joyce
J
Barber
Scott
S
Price
Darrell
D
Moloney
Sue
S
Kimberley
Ann
A
Woolfield
Nick
N
Cadzow
Susan
S
Fiumara
Frank
F
Wilson
Peter
P
Mego
Steve
S
VandeVelde
Dianne
D
Sanders
Sharon
S
O'Rourke
Peter
P
Francis
Paul
P
D000208:Acute Disease; D000280:Administration, Inhalation; D001988:Bronchiolitis / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy
D001993:Bronchodilator Agents; D004837:Epinephrine