Epi + Dex: Unexpected Therapeutic PERC for Bronchiolitis

Abstract

Senior Members| October 01 2009 Epi + Dex: Unexpected Therapeutic PERC for Bronchiolitis AAP Grand Rounds (2009) 22 (4): 40. https://doi.org/10.1542/gr.22-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Epi + Dex: Unexpected Therapeutic PERC for Bronchiolitis. AAP Grand Rounds October 2009; 22 (4): 40. https://doi.org/10.1542/gr.22-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bronchiolitis, pulmonary embolism rule-out criteria, epinephrine, dexamethasone Source: Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360:2079–2089; doi:10.1056/NEJMoa0900544 Investigators from Pediatric Emergency Research Canada (PERC) conducted a double-blind, placebo-controlled trial in which infants with bronchiolitis seen in eight emergency departments (ED) were studied to determine the benefit of using both nebulized epinephrine and corticosteroids compared to placebo or either medication alone. Infants aged 6 weeks to 12 months with bronchiolitis who were seen between 2004 and 2007 were eligible for this study if they had a score of 4–15 on the respiratory distress assessment index (RDAI).1 The RDAI rates wheezing and respiratory distress on a scale from 0–17, with a score below 4 indicating a very mild illness, and a score above 15 very severe illness. Bronchiolitis was defined as the first episode of wheezing associated with signs of an upper respiratory tract infection during the peak respiratory syncytial virus (RSV) season. Infants were excluded if they received a bronchodilator treatment in the ED prior to assessment by a research nurse, had received inhaled or oral corticosteroids during the preceding two weeks, or had a previous episode of wheezing, a diagnosis of asthma, previous bronchodilator use, any chronic cardiopulmonary disease, or immune deficiency. Lethargic infants, infants born at less than 37 weeks who had a corrected age of less than 6 weeks, and infants of parents with limited English proficiency or limited access to a telephone were also excluded. Randomized participants were assigned to one of four study treatment groups: 1) nebulized epinephrine plus oral dexamethasone; 2) nebulized epinephrine plus oral placebo; 3) nebulized placebo plus oral dexamethasone; or 4) nebulized placebo plus oral placebo. The two nebulized treatments were administered 30 minutes apart and consisted of 3 ml of epinephrine in a 1:1,000 solution or 3 ml of saline. The oral dexamethasone dose of 1.0 mg/kg body weight (maximum dose 10 mg) or placebo was given after the first nebulized treatment in the ED followed by five once-daily doses of dexamethasone (0.6 mg/kg; maximum dose 10 mg) or placebo. The primary outcome was hospital admission at enrollment or up to seven days after enrollment. A total of 800 subjects with a mean age of 5 months were randomized. By the seventh day, 34 of the 199 infants in Group 1 (17.1%) had been admitted to the hospital, 47 of the 198 infants in Group 2 (23.7%), 51 of the 199 infants in Group 3 (25.6%), and 53 of the 200 in Group 4 (26.4%). In the unadjusted analysis, only the infants in Group 1 were significantly less likely than those in the placebo group to be admitted by day 7 (RR 0.65; 95% CI, 0.45–0.95). Positive RSV status and disease severity did not affect results. The authors conclude that epinephrine and dexamethasone combined therapy, when compared to placebo, may reduce the rate of hospital admission in the first seven days after an ED visit for bronchiolitis, and may... You do not currently have access to this content.