A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation.
OBJECTIVE
To study patients with respiratory syncytial virus bronchiolitis in respiratory failure to make specific measurements reflecting airway resistance before and after treatment with commonly used agents. We hypothesized that racemic epinephrine would decrease airways resistance more effectively than levalbuterol, and levalbuterol would decrease airways resistance more effectively than racemic albuterol. Normal saline was used as a control.


METHODS
Prospective, randomized, controlled, blinded study.


METHODS
Tertiary Pediatric Intensive Care Unit in a University affiliated hospital in the northeastern United States.


METHODS
Twenty-two patients with respiratory syncytial virus bronchiolitis and in respiratory failure were enrolled. All were intubated and ventilated in a volume control mode and sedated.


METHODS
In a randomized, blinded fashion patients were given four agents: norepinephrine, levalbuterol, racemic albuterol, and normal saline at 6 hr intervals.


METHODS
As indicators of bronchodilation, peak inspiratory pressure and inspiratory respiratory system resistance were measured before and 20 mins after each agent was given. Thus, each patient acted as his/her own control.


RESULTS
There were small but statistically significant decreases in peak inspiratory pressure after racemic epinephrine treatment, levalbuterol, and racemic albuterol. There was no change in peak inspiratory pressure after inhaled normal saline. Inspiratory respiratory system resistance fell significantly after all treatments, including saline. Heart rate rose significantly after inhaled bronchodilator treatments (p < 0.05 for all treatments).


CONCLUSIONS
Similar statistically significant bronchodilation occurred after all three bronchodilators as indicated by a decrease in peak inspiratory pressure and respiratory system resistance, but these changes were small and probably clinically insignificant. However, side effects of bronchodilators, such as tachycardia, also occurred, and these may be clinically significant. Thus the benefit of bronchodilator treatment in these patients is small, does not differ among the drugs we studied and of questionable value.
North Shore Pediatrics PC, Danvers, MA, USA. daniel.l.levin@hitchcock.org
Daniel L
DL
Levin
Abhinav
A
Garg
Leila J
LJ
Hall
Scott
S
Slogic
J Dean
JD
Jarvis
James C
JC
Leiter
D000403:Airway Resistance / Q000187:drug effects; D000420:Albuterol / Q000627:therapeutic use; D001990:Bronchiolitis, Viral / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D064705:Racepinephrine; D012121:Respiration, Artificial; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*
D001993:Bronchodilator Agents; D064705:Racepinephrine; D000420:Albuterol; D004837:Epinephrine