Efficacy of nebulized L‐epinephrine for treatment of croup: a randomized, double‐blind study

Abstract

The objective of this study was to compare the effect of L-epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children. A randomized, double-blind clinical trial was implemented on 174 patients with croup, aged from 6 months to 6 years, and admitted to the Amir Kabir Pediatric Hospital (Arak, Iran). After randomized allocation, patients were administered dexamethasone, and then, they received either saline or L-epinephrine. Westley croup scores, heart rate, respiratory rate, and blood pressure were recorded every half an hour for a total of 120 min. There was a significant difference in mean of croup scores between two groups (P < 0.009). In addition, a significant difference was seen on mean of heart rate between two groups (P < 0.026). Our results showed a considerable difference in reduction of velocity of croup scores in patients who received nebulized L-epinephrine compared to patients who received placebo.

Rebound stridor in children with croup after nebulised adrenaline: does it really exist?

“…This has not been taken up universally, but it is now standard practice in some countries to use steroids and nebulised adrenaline in the emergency department, watch the patients for 2 h and then discharge home if well enough [2]. The final two studies both used steroids and nebulised adrenaline, showing clearly a good response to the treatment with no rebound or indeed any major re-emergence of symptoms [12, 13].…”

“…41 clinical trials were retrieved. A further two studies [12, 13] were considered relevant, in addition to the eight studies included in the Cochrane review. Summaries of the papers are presented in the table 1.…”

Tata Laksana Croup pada Anak

“…Efeknya lebih cepat daripada glucocorticoid, tetapi dianggap terapi lini kedua setelah steroid karena risiko efek samping (takikardi, agitasi, hipertensi) dan durasi kerja yang singkat. 4,16,19 Selain itu, mengingat risiko rebound, anak-anak dalam pengobatan rawat jalan harus diobservasi ketat selama 3 hingga 4 jam setelah pemberian obat sebelum dipulangkan. Dalam pengobatan rawat inap, agen adrenergik dapat digunakan setiap 30 menit, biasanya setiap 3 sampai 4 jam.…”

“…Racemic epinephrine aerosol harus digunakan dengan sangat hati-hati pada pasien dengan takikardi atau anomali jantung, seperti tetralogi Fallot atau stenosis subaortik idiopatik. 4,16,19 Satu uji klinik yang dilakukan secara acak terkontrol menunjukkan bahwa nebulasi 1:1000 L-epinephrine dosis 5 mL aman dan sama efektifnya dengan dosis 0,5 mL racemic epinephrine. Dosis standar ini dapat digunakan Tabel.…”

“…pada semua pasien tanpa memandang usia dan berat badan. 4,16 Heliox (helium-oksigen) dapat mengurangi tingkat keparahan pada anak-anak dengan gejala croup parah. Mekanisme kerja heliox adalah densitas gas helium yang lebih rendah menurunkan turbulensi aliran udara di saluran yang menyempit.…”