title: Does nebulized epinephrine improve the efficacy of hypertonic saline solution in the treatment of hospitalized moderate acute bronchiolitis? A double blind, randomized clinical trial.
abstract: BACKGROUND
  Nebulized 3% hypertonic saline solution (HSS 3%) has proven to reduce hospital stay in infants with acute bronchiolitis, as compared with nebulized physiological saline solutions. There are no studies assessing the effectiveness of nebulized epinephrine in patients treated with HSS 3%. The aim of this study was to compare the length of stay (LOS) in hospitalized patients treated with HSS 3% with placebo vs. HSS 3% with epinephrine. Secondarily we aimed to assess the effectiveness and safety of both treatments.
  
  
  METHODS
  We performed a prospective, randomized, double-blind, parallel-group study, including infants hospitalized for moderate acute bronchiolitis. Both groups received standard life support and were randomly treated with nebulized HSS 3% (7 mL) with either placebo 3 mL or epinephrine 3 mL. Nebulizations were initially administered every four hours and this interval was modified according to the patient's response.
  
  
  RESULTS
  Sixty-four infants were included, 32 patients in each group. No statistically significant differences were found between the two groups (P=0.948) in length of stay, disease severity, SatO2, respiratory rate or heart rate. On the third day of hospitalization, severity and respiratory rate in the HSS 3%+E presented a non statistically significant trend to an earlier improvement, (P=0.063 and P=0.096 repectively). No adverse events occurred. Four patients (two from each group) required transfer to the pediatric intensive care unit.
  
  
  CONCLUSIONS
  With a third of the final estimated sample, we find a trend to an earlier clinical recovery in the epinephrine group, even though no statistical significant differences in LOS were found. The study needs to be continued until the total sample is recruited.
authors.affiliation: Department of Pediatrics, Puerta del Mar University Hospital, Cádiz, Spain - carlosflogon@gmail.com.
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Flores-González
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Dominguez-Coronel
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Matamala Morillo
authors.forename: Miriam
authors.initials: M
authors.lastname: Aragón Ramírez
authors.forename: Rosa María
authors.initials: RM
authors.lastname: García Ortega
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Dávila Corrales
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: García Palacios
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Perez Guerrero
authors.forename: Laura
authors.initials: L
authors.lastname: García García
authors.forename: Alfonso María
authors.initials: AM
authors.lastname: Lechuga Sancho
mesh_terms: D000208:Acute Disease; D001988:Bronchiolitis / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic; D004837:Epinephrine