Epinephrine for bronchiolitis

Variation in the Management of Infants Hospitalized for Bronchiolitis Persists after the 2006 American Academy of Pediatrics Bronchiolitis Guidelines

“…Despite the evidence for racemic epinephrine showing small benefits over albuterol, albuterol use remains substantially higher than racemic epinephrine use, particularly after excluding patients with asthma. (22, 23) When the use of these nebulized therapies was examined individually in our study, use did not decline over the study period and the variability in the use of both agents was significant. The AAP guideline clearly recommends against routine use of these agents, but does offer an option for a carefully monitored trial of bronchodilators with objective scoring to assess improvement, which may account for the substantial variation.…”

Variation in the Management of Infants Hospitalized for Bronchiolitis Persists after the 2006 American Academy of Pediatrics Bronchiolitis Guidelines

“…Despite the evidence for racemic epinephrine showing small benefits over albuterol, albuterol use remains substantially higher than racemic epinephrine use, particularly after excluding patients with asthma. (22, 23) When the use of these nebulized therapies was examined individually in our study, use did not decline over the study period and the variability in the use of both agents was significant. The AAP guideline clearly recommends against routine use of these agents, but does offer an option for a carefully monitored trial of bronchodilators with objective scoring to assess improvement, which may account for the substantial variation.…”

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

“…Epinephrine, as an adrenergic agent, might theoretically cause tachycardia, sweating, pallor, trembling, or even more serious events such as arrhythmias. However, previous studies 7 suggest no serious or frequent short‐term harms from nebulized epinephrine in the absence of comorbidities. Nebulized HS seems to be safe as well; studies from Zhang et al 16,17 show good tolerability and very low rate of serious AEs, reporting only one case of transient bradycardia and desaturation possibly related to nebulized HS.…”

Outpatient Medications Deimplemented by the AAP Bronchiolitis Guidelines: An Umbrella Review of Meta‐Analyses

“…Two meta‐analyses and two network meta‐analyses were included [33–36]. Two of the meta‐analyses are Cochrane reviews titled, Epinephrine for Bronchiolitis (Review) [34, 35]. Comparisons of epinephrine with placebo or with other medications were included.…”

“…All four included meta‐analyses found evidence that nebulized epinephrine decreased respiratory distress and/or hospital admissions in the outpatient setting. Clinical improvement was reported in three of four studies [34–36] and reductions in admission rate on Day 1 were noted in three of four meta‐analyses [33, 35, 36]. See Figures 2 and 3, Albatross plots of Meta‐analyses of randomized controlled trials (RCTs) of epinephrine and normal saline (NS) Placebo in Bronchiolitis, showing the estimates of epinephrine versus placebo on hospitalization and clinical scores, respectively.…”

Variation in the Management of Infants Hospitalized for Bronchiolitis Persists after the 2006 American Academy of Pediatrics Bronchiolitis Guidelines

“…Despite the evidence for racemic epinephrine showing small benefits over albuterol, albuterol use remains substantially higher than racemic epinephrine use, particularly after excluding patients with asthma. (22, 23) When the use of these nebulized therapies was examined individually in our study, use did not decline over the study period and the variability in the use of both agents was significant. The AAP guideline clearly recommends against routine use of these agents, but does offer an option for a carefully monitored trial of bronchodilators with objective scoring to assess improvement, which may account for the substantial variation.…”

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

“…Epinephrine, as an adrenergic agent, might theoretically cause tachycardia, sweating, pallor, trembling, or even more serious events such as arrhythmias. However, previous studies 7 suggest no serious or frequent short‐term harms from nebulized epinephrine in the absence of comorbidities. Nebulized HS seems to be safe as well; studies from Zhang et al 16,17 show good tolerability and very low rate of serious AEs, reporting only one case of transient bradycardia and desaturation possibly related to nebulized HS.…”

Outpatient Medications Deimplemented by the AAP Bronchiolitis Guidelines: An Umbrella Review of Meta‐Analyses

“…Two meta‐analyses and two network meta‐analyses were included [33–36]. Two of the meta‐analyses are Cochrane reviews titled, Epinephrine for Bronchiolitis (Review) [34, 35]. Comparisons of epinephrine with placebo or with other medications were included.…”

“…All four included meta‐analyses found evidence that nebulized epinephrine decreased respiratory distress and/or hospital admissions in the outpatient setting. Clinical improvement was reported in three of four studies [34–36] and reductions in admission rate on Day 1 were noted in three of four meta‐analyses [33, 35, 36]. See Figures 2 and 3, Albatross plots of Meta‐analyses of randomized controlled trials (RCTs) of epinephrine and normal saline (NS) Placebo in Bronchiolitis, showing the estimates of epinephrine versus placebo on hospitalization and clinical scores, respectively.…”

Variation in the Management of Infants Hospitalized for Bronchiolitis Persists after the 2006 American Academy of Pediatrics Bronchiolitis Guidelines

“…Despite the evidence for racemic epinephrine showing small benefits over albuterol, albuterol use remains substantially higher than racemic epinephrine use, particularly after excluding patients with asthma. (22, 23) When the use of these nebulized therapies was examined individually in our study, use did not decline over the study period and the variability in the use of both agents was significant. The AAP guideline clearly recommends against routine use of these agents, but does offer an option for a carefully monitored trial of bronchodilators with objective scoring to assess improvement, which may account for the substantial variation.…”

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

“…Epinephrine, as an adrenergic agent, might theoretically cause tachycardia, sweating, pallor, trembling, or even more serious events such as arrhythmias. However, previous studies 7 suggest no serious or frequent short‐term harms from nebulized epinephrine in the absence of comorbidities. Nebulized HS seems to be safe as well; studies from Zhang et al 16,17 show good tolerability and very low rate of serious AEs, reporting only one case of transient bradycardia and desaturation possibly related to nebulized HS.…”

Outpatient Medications Deimplemented by the AAP Bronchiolitis Guidelines: An Umbrella Review of Meta‐Analyses

“…Two meta‐analyses and two network meta‐analyses were included [33–36]. Two of the meta‐analyses are Cochrane reviews titled, Epinephrine for Bronchiolitis (Review) [34, 35]. Comparisons of epinephrine with placebo or with other medications were included.…”

“…All four included meta‐analyses found evidence that nebulized epinephrine decreased respiratory distress and/or hospital admissions in the outpatient setting. Clinical improvement was reported in three of four studies [34–36] and reductions in admission rate on Day 1 were noted in three of four meta‐analyses [33, 35, 36]. See Figures 2 and 3, Albatross plots of Meta‐analyses of randomized controlled trials (RCTs) of epinephrine and normal saline (NS) Placebo in Bronchiolitis, showing the estimates of epinephrine versus placebo on hospitalization and clinical scores, respectively.…”