OBJECTIVES:
Inhaled L-epinephrine is a known treatment of severe croup and postextubation upper airway obstruction. L-epinephrine can be delivered continuously in the vapor phase, but the indications, safety, and efficacy of this novel practice have yet to be evaluated. Theoretical risks are tachycardia, hypertension, and dysrhythmias. The study objective was to describe patient characteristics and vital sign changes related to continuous vaporized L-epinephrine use in critically ill children with the hypothesis that it can be practically and safely administered to children with subglottic edema and lower airway obstruction.
DESIGN:
Retrospective cohort study.
SETTING:
PICU and cardiothoracic ICU in a tertiary academic children’s hospital.
PATIENTS:
Patients age 0–21 years treated with continuous vaporized L-epinephrine from 2013 to 2019.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Continuous vaporized L-epinephrine was administered 140 times to 129 subjects via a high-flow nasal oxygen device. The median age was 10.6 months (1.3; interquartile range, 4.8–17.1 mo). The most common indications were lower respiratory tract obstruction (45%), postextubation subglottic edema (31%), and croup (16%). Eighty-eight percent had no escalation of respiratory support within 24 hours of initiation of continuous vaporized L-epinephrine, 5% progressed to require endotracheal intubation, and 3% were reintubated within 24 hours of initiation of continuous vaporized L-epinephrine following an extubation attempt. After starting continuous vaporized L-epinephrine, 85% of subjects had a decrease in heart rate and 80% had a decrease in respiratory rate. Six subjects had an increase in heart rate, and eight had an increase in blood pressure of more than 20% from baseline. These subjects did not receive interventions specific to these vital sign changes, including discontinuation of continuous vaporized L-epinephrine.
CONCLUSIONS:
Continuous vaporized L-epinephrine was safely administered to critically ill children with most subjects demonstrating a decrease in heart rate, blood pressure, and respiratory rate.
RESUMO -Estudo das variações do EEG paroxístico provocadas pelo uso do hidrato de cloral a 20%, na dose de 50mg/Kg, na indução do sono em 50 crianças epilépticas de 1 a 12 anos de idade, em monoterapia ou sem anticonvulsivantes. Foi observado que o hidrato de cloral é capaz de induzir o sono sem efeitos colaterais e é capaz de modificar o EEG em sono, melhorando a organização dos fusos de sono e diminuindo os paroxismos generalizados.PALAVRAS-CHAVE: hidrato de cloral, EEG em sono, epilepsia.Comparison between natural sleep EEG and chloral hydrate induced sleep EEG: paroxystic changes and baseline rythms SUMMARY -EEG changes associated with the use of chloral hydrate (50 mg/Kg) to induce sleep were evaluated in 50 epileptic children (ages 1 to 12 years), either taking no anticonvulsants or on monotherapy. It was observed that chloral hydrate was capable of inducing sleep without side effects and was capable of modifying the sleep EEG, improving organization of sleep spindles and generalized paroxysms.
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