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Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care
Ben Gelbart1, Brent McSharry2, Carmel Delzoppo3
1Royal Children's Hospital Paediatric Intensive Care Unit, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Systemic corticosteroids and nebulized epinephrine significantly reduced the duration of positive pressure support in infants with severe bronchiolitis. This combination therapy offers a promising approach for managing pediatric intensive care cases.
Area of Science:
- Pediatrics
- Pulmonology
- Critical Care Medicine
Background:
- Bronchiolosis is a common viral respiratory infection in infants.
- Severe cases often require intensive care with positive pressure support.
- Current standard care has limitations in reducing support duration.
Purpose of the Study:
- To evaluate the efficacy of combining systemic corticosteroids and nebulized epinephrine versus standard care.
- To determine the impact on the duration of positive pressure support in pediatric intensive care.
Main Methods:
- A pragmatic, multicenter, open-label, randomized trial involving children under 18 months with bronchiolitis.
- Intervention group received prednisolone and nebulized epinephrine.
- Control group received standard care.
Main Results:
- The corticosteroid-epinephrine group had a significantly shorter duration of positive pressure support (26 hours) compared to the control group (40 hours).
- The adjusted ratio for support duration was 0.66 (95% CI, 0.51-0.84), P = .001.
- Adverse event rates were similar between the intervention (38%) and control (38%) groups.
Conclusions:
- Combination therapy with systemic corticosteroids and inhaled epinephrine effectively reduces the duration of positive pressure support in children with severe bronchiolitis.
- This treatment strategy shows promise for improving outcomes in pediatric intensive care settings.
Objective:
To determine whether the combination of systemic corticosteroids and nebulized epinephrine, compared with standard care, reduces the duration of positive pressure support in children with bronchiolitis admitted to intensive care.
Study Design:
We performed a pragmatic, multicenter, open-label, randomized trial between July 2013 and November 2019 in children younger than 18 months old with a clinical diagnosis of bronchiolitis. The intervention group received the equivalent of 13 mg/kg prednisolone over 3 days, then 1 mg/kg daily for 3 days, plus 0.05 mL/kg of nebulized 1% epinephrine made up to 6 ml with 0.9% saline via jet nebulizer and mask using oxygen at 12 l/min every 30 minutes for 5 doses, then 1-4 hourly for 3 days, then as required for 3 days. The primary outcome was clinician-managed duration of positive pressure support in intensive care defined as high-flow nasal-prong oxygen, nasopharyngeal continuous positive airway pressure, or mechanical ventilation.
Results:
In total, 210 children received positive pressure support. In the corticosteroid-epinephrine group, 107 children received positive pressure support for a geometric mean of 26 (95% CI, 22-32) hours compared with 40 (95% CI 34-47) hours in 103 controls, adjusted ratio 0.66 (95% CI 0.51-0.84), P = .001. In the intervention group, 41 (38%) children experienced at least 1 adverse event, compared with 39 (38%) in the control group.
Conclusions:
In children with severe bronchiolitis, the duration of clinician-managed pressure support was reduced by regular treatment with systemic corticosteroids and inhaled epinephrine compared with standard care.
Clinical Trial Registration:
Australian Clinical Trials Research Network: ACTRN12613000316707.
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