Inhaled L-Epinephrine As a Rescue Therapy in Critical Bronchiolitis

Area of Science:

• Pediatric critical care medicine
• Respiratory medicine
• Pharmacology

Background:

• Viral bronchiolitis is a primary cause for pediatric intensive care unit (PICU) admissions.
• Current guidelines emphasize supportive care for bronchiolitis.
• Continuous inhaled epinephrine (CIE) via heated high-flow nasal cannula (HFNC) is a potential therapeutic option.

Purpose of the Study:

• To characterize patients with bronchiolitis who received CIE.
• To compare the physiological response to CIE versus conventional therapy.
• To evaluate CIE as a novel treatment for severe bronchiolitis.

Main Methods:

• A single-center retrospective cohort study included 193 children (0-2 years) admitted to the PICU with bronchiolitis (2017-2023).
• Demographic and clinical data were collected.
• Physiologic response was assessed using vital signs and the ROX-HR index.

Main Results:

• Patients receiving CIE were younger, smaller, and presented with higher peak respiratory rates, indicating more severe illness.
• CIE patients showed higher respiratory rates and lower ROX-HR indices initially.
• Within 48 hours, CIE treatment led to more rapid improvements in respiratory rate and ROX-HR index compared to conventional therapy.

Conclusions:

• CIE was administered to younger, smaller patients with more severe bronchiolitis.
• Physiologic improvements suggest CIE may benefit patients not responding to conventional HFNC therapy.
• This study highlights CIE as a potential therapeutic strategy for critical bronchiolitis.