Abstract | OBJECTIVE: 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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Authors | Ben Gelbart, Brent McSharry, Carmel Delzoppo, Simon Erickson, Katherine Lee, Warwick Butt, Miriam Rea, Xiaofang Wang, John Beca, Alex Kazemi, Frank Shann |
Journal | The Journal of pediatrics
(J Pediatr)
Vol. 244
Pg. 17-23.e1
(05 2022)
ISSN: 1097-6833 [Electronic] United States |
PMID | 35093318
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
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Copyright | Copyright © 2022 Elsevier Inc. All rights reserved. |
Chemical References |
- Adrenal Cortex Hormones
- Saline Solution
- Oxygen
- Epinephrine
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Topics |
- Adrenal Cortex Hormones
(therapeutic use)
- Australia
- Bronchiolitis
(drug therapy)
- Child
- Critical Care
- Epinephrine
(therapeutic use)
- Humans
- Infant
- Oxygen
(therapeutic use)
- Saline Solution
(therapeutic use)
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