title: Nebulized 0.5, 2.5 and 5 ml L-epinephrine for post-extubation stridor in children: a prospective, randomized, double-blind clinical trial.
abstract: OBJECTIVE
  Nebulized L-epinephrine has been recommended for the treatment of viral croup. However, the few studies assessing its effect on post-extubation stridor (PES) have shown conflicting results. We compared the efficacy and safety of nebulized L-epinephrine at three different doses for the treatment of PES.
  
  
  METHODS
  We conducted a prospective, randomized, double-blind trial including all consecutive children with a PES score of ≥4 (Westley score). The primary efficacy outcome was change in PES score at 40 min. A reduction of ≥2 points in stridor score was defined as clinically significant. A total of 96 patients were randomly assigned to receive one of three doses of nebulized L-epinephrine upon achieving a PES score of 4 or more following extubation. Stridor score and vital signs were recorded before treatment, and at 20, 40, 60 and 180 min after nebulization.
  
  
  RESULTS
  Baseline characteristics were similar among all study groups. No significant difference was detected among the treatments based on change in Westley score by intent-to-treat analysis. In addition, the difference in the number of patients who clinically improved among the treatment groups was not significant (p = 0.54). Patients receiving 5 ml nebulized epinephrine had a significant increase of systolic and diastolic blood pressure at 40 and 180 min.
  
  
  CONCLUSIONS
  Nebulized L-epinephrine at doses of 0.5, 2.5 and 5 ml demonstrated a lack of dose response in effect on PES and a modestly clinically significant increase in undesired side effects (heart rate and blood pressure) at higher doses.
authors: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, Rua Castro Alves, 60, São Paulo 01532-900, Brazil. psls.nat@terra.com.br
authors: Paulo Sérgio Lucas
authors: PS
authors: da Silva
authors: Marcelo Cunio Machado
authors: MC
authors: Fonseca
authors: Simone Brasil Oliveira
authors: SB
authors: Iglesias
authors: Emílio Lopes
authors: EL
authors: Junior
authors: Vânia Euzébio
authors: VE
authors: de Aguiar
authors: Werther Brunow
authors: WB
authors: de Carvalho
mesh_terms: D060666:Airway Extubation; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000187:drug effects*
chemical_list: D004837:Epinephrine