This pilot study was conducted to profile safety of nebulized
racemic epinephrine when used as a
therapy for
smoke inhalation injury in severely burned children. We enrolled 16 patients who were 7 to 19 years of age ([mean ± SD], 12 ± 4 years) with
burns covering more than 30% of the TBSA (55 ± 17%) and
smoke inhalation injury, as diagnosed by bronchoscopy at burn center admission. Patients were randomized to receive either standard of care (n = 8), which consisted of nebulized
acetylcysteine, nebulized
heparin, and nebulized
albuterol, or to receive standard of care plus nebulized
epinephrine (n = 8). Primary endpoints were death,
chest pain, and adverse changes in cardiopulmonary hemodynamics (
arrhythmia, arterial blood pressure, electrocardiographic [ST segment] changes, and peak inspiratory pressure). Additional endpoints included total days on
ventilator, pulmonary function, and physiological cardiopulmonary measurements at intensive care unit discharge. No adverse events were observed during or after the nebulization of
epinephrine, and no deaths were reported that were attributable to the administration of nebulized
epinephrine. The groups did not significantly differ with regard to age, sex,
burn size, days on
ventilator, pulmonary function, or cardiopulmonary fitness. Results of this pilot trial indicate
epinephrine to be safe when administered to pediatric
burn patients with
smoke inhalation injury. Current data warrant future efficacy studies with a greater number of patients.