Efficacy of Subcutaneous Epinephrine versus Nebulized Salbutamol in the Emergency Department Treatment of Bronchiolitis………………………………………………………………….………
Kerbala Journal of Medicine,
Volume 2, Issue 5, Pages 548-562
Abstractbackground: By age 2 years, 50% of children will have been infected with
bronchiolitis, with severe disease more common among infants aged 1–3
months. Despite wide spread use of nebulized B2-agonists in infants with
bronchiolitis since the late 1950s, the efficacy of these drugs remains unproven.
Statistical improvement in clinical scoring systems seen with the use of beta agonists
is not always clinically significant, and desaturations have been reported after
salbutamol nebulization. Epinephrine hydrochloride is being used with increasing
frequency in bronchiolitis. Subcutaneous administration of it may produce its effects
within 10 minutes and maximal effects in about 30 minutes.
Aim of the study: To determine the efficacy of S.C Epi. versus Neb. salbutamol in
the Emergency Department treatment of patients (age 2 years or less) with
Patients and method: Two hundreds patients less than 2 years of age with a clinical
diagnosis of bronchiolitis were enrolled in a prospective, randomized and controlled
study to receive either subcutaneous epinephrine (n=100) or nebulized 0.5%
salbutamol sulfate (n=100). This study was done in the Emergency Department of
Babylon maternity and children teaching hospital. Study enrollment occurred in
sequential winter season from the first of September 2007 to the first of March 2008.
Results: There is high significant improvement in O2 saturation at 30 and 60 min., in
respiratory rate at 60 and 90 min., heart rate improvement at 60 min. and better
improvement in the wheeze, chest retraction, nasal flaring, and reduced rate of
admission to the wards in patient who were treated with subcutaneous epinephrine
than those who were treated with nebulized salbutamol.
Conclusions: The response to subcutaneous epinephrine in patients younger than 12
months was better than older patients. Subcutaneous epinephrine improves the
clinical manifestation and parameters of respiratory distress with maximum
effectiveness at 30-60 min. Subcutaneous epinephrine decreases the load of patients
on E.D and reduces the rate of admission to the wards in comparison with nebulized
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