title: Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial.
abstract: OBJECTIVE
  There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline.
  
  
  METHODS
  We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay.
  
  
  RESULTS
  A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively).
  
  
  CONCLUSIONS
  In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before.
  
  
  BACKGROUND
  EudraCT 2009-016042-57.
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: J Carlos
authors.initials: JC
authors.lastname: Flores-González
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Matamala-Morillo
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodríguez-Campoy
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Pérez-Guerrero
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Serrano-Moyano
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Comino-Vazquez
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Encarnación
authors.initials: E
authors.lastname: Palma-Zambrano
authors.affiliation: Department of Pharmacy, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Bulo-Concellón
authors.affiliation: Foundation for Biomedical Research Management, Cádiz, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Santos-Sánchez
authors.affiliation: Department of Clinical Pediatrics, Hospital Universitario Puerta del Mar, Cádiz, Spain.|Department of Maternal and Child Health Care and Radiology, University of Cádiz, Cádiz, Spain.
authors.forename: Alfonso M
authors.initials: AM
authors.lastname: Lechuga-Sancho
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D001988:Bronchiolitis / Q000188:drug therapy* / Q000473:pathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009330:Nebulizers and Vaporizers; D015990:Placebo Effect; D056152:Respiratory Rate; 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