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Related Experiment Videos

Epinephrine for bronchiolitis.

L Hartling1, N Wiebe, K Russell

  • 1Department of Pediatrics, University of Alberta, Aberhart Centre One, 11402 University Avenue, Room 9424, Edmonton, Alberta, Canada, T6G 2J3.

The Cochrane Database of Systematic Reviews
|February 20, 2004
PubMed
Summary
This summary is machine-generated.

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Epinephrine may offer benefits for outpatient bronchiolitis treatment compared to placebo and salbutamol, but evidence for inpatients is insufficient. Further large trials are needed to confirm effectiveness and develop better assessment tools for this common infant respiratory illness.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Evidence-Based Medicine

Background:

  • Bronchodilators are standard treatment for bronchiolitis in infants.
  • Previous reviews indicate modest short-term benefits for mild to moderate cases.

Purpose of the Study:

  • To compare the efficacy of epinephrine against placebo and other bronchodilators in infants under two years old diagnosed with bronchiolitis.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) from multiple databases (CENTRAL, MEDLINE, EMBASE).
  • Inclusion criteria: RCTs comparing epinephrine to placebo or other bronchodilators in infants with bronchiolitis, with quantitative outcomes.
  • Study quality assessed using Jadad scale; data extracted and analyzed separately for placebo and non-epinephrine bronchodilator control groups, and for inpatient vs. outpatient settings.

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Main Results:

  • Fourteen RCTs were included; study quality varied.
  • Inpatient studies: Epinephrine showed a significant improvement in clinical score at 60 minutes versus placebo (SMD -0.52).
  • Outpatient studies: Epinephrine favored clinical score, oxygen saturation, respiratory rate, and improvement versus placebo. Compared to salbutamol, epinephrine improved oxygen saturation, heart rate, respiratory rate, and "improvement," but increased pallor.

Conclusions:

  • Insufficient evidence supports epinephrine use for inpatient bronchiolitis.
  • Some evidence suggests outpatient epinephrine may be more effective than salbutamol and placebo.
  • Large, multi-center trials are needed to confirm outpatient efficacy, and a validated scoring system for bronchiolitis is required.