A Randomized Comparison of Helium–Oxygen Mixture (Heliox) and Racemic Epinephrine for the Treatment of Moderate to Severe Croup

Objective. To compare the additive effect of a helium–oxygen mixture (Heliox) or racemic epinephrine (RE) on croup scores (CSs) in children with moderate to severe croup treated with humidified oxygen and steroids. Design. A prospective, randomized, double-blind trial. Setting. Emergency department and pediatric intensive care unit of an urban level I trauma center. Participants. Randomly assigned, consecutive children ages 6 months to 3 years presenting with moderate to severe croup (CS: ≥5). Interventions. After cool humidified oxygen and 0.6 mg/kg of intramuscular dexamethasone, patients were randomized to receive either Heliox or RE. Vital signs, oxygen saturation, and CSs were recorded at regular intervals. Outcome/Analysis. Reductions in CSs were compared using repeated-measures analysis of variance. Results. Thirty-three patients were enrolled. Three were excluded because of protocol violations, and 1 was excluded because of lack of documentation, leaving 29 patients for final analysis. The average age was 24.2 months, 20 were male (68.8%). Both Heliox and RE were associated with improvement in CSs over time. There were no significant differences in mean CS, oxygen saturation, respiratory rate, or heart rate between groups at baseline or at the end of the treatment period. Conclusion. In patients with moderate to severe croup, the administration of Heliox resulted in similar improvements in CS compared with patients given RE.