Nebulized 0.5, 2.5 and 5 ml l-epinephrine for post-extubation stridor in children: a prospective, randomized, double-blind clinical trial
| Autor: | Marcelo Cunio Machado Fonseca, Paulo Sérgio Lucas da Silva, Simone Brasil de Oliveira Iglesias, Werther Brunow de Carvalho, Vânia Euzébio de Aguiar, Emilio Lopes Junior |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Epinephrine medicine.medical_treatment Stridor Airway Extubation Critical Care and Intensive Care Medicine law.invention Double-Blind Method Randomized controlled trial law Intensive care otorhinolaryngologic diseases Humans Medicine Intubation Prospective Studies Child Prospective cohort study Respiratory Sounds business.industry Nebulizers and Vaporizers Infant medicine.disease body regions Clinical trial Child Preschool Croup Anesthesia Female medicine.symptom business human activities |
| Zdroj: | Intensive Care Medicine. 38:286-293 |
| ISSN: | 1432-1238 0342-4642 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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