Nebulized Racemic Epinephrine by IPPB for the Treatment of Croup. A Double-Blind Study

Westley, C. Ross; Cotton, Ernest K.; Brooks, John

doi:10.1097/00132586-197908000-00043

Cited by 59 publications

(92 citation statements)

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“…Nebulised epinephrine by intermittent positive pressure breathing improves croup scores within 30 min of treatment but the benefit lasts for ,2 h [216,217]. Epinephrine by nebulisation alone was found to be as effective as nebulisation using intermittent positive pressure breathing [218].…”

Section: Epinephrinementioning

confidence: 97%

Medicines used in respiratory diseases only seen in children

Lenney¹,

Al²,

Bont³

et al. 2009

European Respiratory Journal

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Detailed literature searches were carried out in seven respiratory disease areas. Therapeutic evidence for efficacy of medicinal products was assessed using the Grades of Recommendation, Assessment and Evaluation (GRADE) methodology, as well as an assessment of safety and side-effects.Systemic corticosteroids may reduce the development of bronchopulmonary dysplasia but have serious side-effects. Antioxidants need further study to demonstrate whether they have long-term benefits. Treatments for acute bronchiolitis have shown little benefit but new antiviral and monoclonal antibodies need further assessment. Well-constructed studies are needed to confirm the value of inhaled corticosteroids and/or montelukast in the management of viralinduced wheeze. Corticosteroids are the treatment of choice in croup. Minimal or no information is available for the treatment of congenital lung abnormalities, bronchiolitis obliterans and interstitial lung disease.

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Section: Epinephrinementioning

confidence: 97%

Medicines used in respiratory diseases only seen in children

Lenney¹,

Al²,

Bont³

et al. 2009

European Respiratory Journal

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“…History of an atopic disease (atopic dermatitis, asthma, allergic rhinitis, food allergy) was also recorded. Patients were categorized according to the Westley Croup Score as mild (0-2), moderate (3)(4)(5)(6)(7)(8), or severe (>8) 8 .…”

Section: Study Populationmentioning

confidence: 99%

Are cytokines and cortisol important predictors for the severity of pediatric croup: A case control study

et al. 2017

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The aim of this study is to investigate the role of cytokines (TNF-α, IL-6, IL-10, and PAF), cortisol, and IgE in the pathogenesis of croup and the factors determining its clinical severity. Patients diagnosed with croup at the Pediatric Emergency Department were included and thirty healthy children were included as a control group. Patients' demographic characteristics, clinical findings, recurrent croup history, and patient-family atopy history were recorded. Patients were grouped according to the Westley croup scoring system. Blood samples were taken from the control group and the patients for cytokines and cortisol. Respiratory pathogens were studied with PCR. Sixty-nine pediatric cases who were diagnosed as croup were included in the study (34 mild, 31 moderate, 4 severe). Group comparisons were made in terms of mild and moderate/severe groups. In the moderate/severe group, IL-10 and cortisol levels were higher than the mild group. The moderate/ severe cortisol levels between 12:00 am-6:00 pm were found to be higher. PAF and TNF-alpha levels were detected to be higher in patients with a history of atopy. Viral agents were isolated in 45 patients; rhinovirus PCR tests were positive in 22 patients.In this study, rhinovirus was the most common etiology for croup. Increased levels of IL-10 and cortisol in the moderate/severe group indicate that different systemic and local mechanisms may play a role in the pathogenesis of croup.

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“…Twelve items (level of consciousness or mental status, inspiratory breath sounds, air entry, stridor, cough, cyanosis or colour, anxiety or air hunger, retractions and/or flaring, respiratory rate and heart rate, oxygen saturation and respiratory distress) were identified from 10 croup scoring instruments (6,(8)(9)(10)(11)(12)(13)(14)(15)(16) (Table 1). Five other scoring instruments modified single items in a previously published score (17)(18)(19).…”

Section: Item Identificationmentioning

confidence: 99%

Interobserver variability of croup scoring in clinical practice

Chan

Langley

LeBlanc

2001

Paediatrics &Amp; Child Health

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BACKGROUND: Viral laryngotracheobronchitis croup is the most common cause of acute upper airway obstruction in young children. Clinical assessment of children with croup is often performed using 'croup scores'; however, these scores have not been validated outside of the research setting. OBJECTIVE: To determine the reliability of clinical observation items in croup scores in a paediatric emergency department (ED) setting. DESIGN: Literature review identified 12 observation items (level of consciousness or mental status, inspiratory breath sounds, air entry, stridor, cough, cyanosis or colour, anxiety or air hunger, retractions and/or flaring, respiratory rate and heart rate, oxygen saturation and respiratory distress); overlapping items were combined, yielding 10 variables. In a prospective cohort study over 13 months, patients presenting with croup were observed independently, and croup scores were assigned by the triage nurse, ED nurse and the ED physician before treatment. Agreement among observers for clinical observations was analysed using Cohen's quadratic weighted kappa. SETTING: University-affiliated, paediatric hospital ED providing primary care to an urban area (population 330,000). PATIENTS: Children aged three months to five years presenting with viral croup (preceding history of at least one day of upper respiratory tract symptoms associated with barking cough and/or hoarseness and/or stridor). RESULTS: One hundred fifty-eight children meeting inclusion criteria for croup were assessed by three observers within 1 h of each other's assesments and before treatment. Interobserver agreement among the three observers using weighted kappa was greater than chance for all clinical observation items and ranged from fair to moderate (0.2 to 0.4 and 0.4 to 0.6, respectively). CONCLUSIONS: In the busy practice setting of a paediatric ED, substantial interobserver variability exists among health care providers in the measurement of respiratory signs associated with croup in young children. Based on the present study in a practice setting and two research

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Nebulized Racemic Epinephrine by IPPB for the Treatment of Croup. A Double-Blind Study

Cited by 59 publications

References 0 publications

Medicines used in respiratory diseases only seen in children

Medicines used in respiratory diseases only seen in children

Are cytokines and cortisol important predictors for the severity of pediatric croup: A case control study

Interobserver variability of croup scoring in clinical practice

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