A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis
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Acute Bronchiolitis
Bronchodilator Agents
Acute bronchiolitis is the most common lower respiratory tract infection of children younger than 2 years of age. Although the diagnose is clinical and the severity plays an important role in treatment, there aren't any standardized diagnostic criterias and severity assessment classifications for acute bronchiolitis available in literature. Results of the recent studies suggest that one of the platelet activation indice, MPV, can be used as an acute phase reactant in diseases. MPV has shown to be effected in local inflammations and to our knowledge there's only one recent study in children with acute bronchiolitis that demonstrates a decrease in MPV. Therefore more studies are needed to clarify the relation between MPV and acute bronchiolitis. In this present study we aim to determine the association between MPV and acute bronchiolitis, also identify whether it’s a useful marker on assessing disease severity or not. In this retrospective study we enrolled 555 children diagnosed with Acute bronchiolitis and 516 healthy infants with a matching age and sex. MPV levels were found significantly higher in patient group (8,2 ± 0,8 fL) than the control group (7,9 ± 0,8 fL). In terms of hospitalization need no significant difference detected between the MPV values of hospitalized group and outpatients, 8,3±0,8 fL; 8,2±0.7 fL respectively. In conclusion, our data show that MPV values significantly elevate in acute bronchiolitis compared to healthy infants. However, MPV can't be used as a guidance in attack severity nor can predict hospitalization, PICU admittion, and systemic steroid need.
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About 12% of infants develop bronchiolitis in their first year. Results from several recent studies have indicated that bronchodilator treatments are not efficacious for bronchiolitis, but use of epinephrine is increasing in infants. To examine epinephrine's efficacy for treating bronchiolitis, researchers performed a meta-analysis of …
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We compared the effects of distilled water and normal saline as diluents for the endobronchial administration of epinephrine in anesthetized dogs by using a cross-over design. Six dogs received 2 mL of either normal saline or distilled water into the bronchus, and the other solution was administered 1 wk later. Eight dogs received 0.02 mg/kg epinephrine diluted in either distilled water (E + water) or normal saline (E + saline) to a total volume of 2 mL into the bronchus, and the other solution was administered 1 wk later. Normal saline or distilled water without epinephrine did not affect the plasma epinephrine concentration, mean arterial pressure (MAP), and Pao2. The peak plasma epinephrine concentration was significantly larger after treatment with E + water (26.5 ± 7.9 ng/mL) than after E + saline (2.1 ± 0.7 ng/mL). E + water caused an increase in MAP of 91 ± 24 mm Hg, whereas E + saline did not affect MAP. The maximal decrease in Pao2 after the administration of E + water (14 ± 5 mm Hg) was significantly greater than after E + saline (7 ± 2 mm Hg). In conclusion, distilled water as the diluent for endobronchially administered epinephrine to a total volume of 2 mL allowed better absorption of epinephrine compared with normal saline without a serious detrimental effect on Pao2. Implications Using a small volume of distilled water as the diluent for endobronchial epinephrine administration significantly increased epinephrine absorption and arterial pressure in comparison with normal saline, without having a serious detrimental effect on Pao2, in an anesthetized, noncardiopulmonary, resuscitation dog model.
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Introduction: Determining the severity of acute bronchiolitis in children is important for the clinical management of the disease. Therefore, we aimed to reveal their prognostic importance by examining cardiac markers in our patients with acute bronchiolitis. Materials and Methods: We conducted a single-center retrospective, observational study with children with acute bronchiolitis between 1 month and 2 years of age, between December 2020 and December 2021, who were covid-19 PCR test negative and had no covid-19 contact. We scanned demographic, clinical and laboratory parameters from medical records. Results: A total of 45 (44% female) children with acute bronchiolitis, a median (IQR) age of 5 (5) months were included in the study. There were 7 (16%) mild bronchiolitis, 23 (51%) moderate and 15 (33%) severe bronchiolitis patients. The cutoff point of Nt-proBNP to be ≥1025 ng/L to predict severe bronchiolitis with a sensitivity of 71% and a specificity of 80 % at admission in children with acute bronchiolitis. Conclusion: We think that the threshold value for Nt-proBNP in the study can be used to identify patients with severe bronchiolitis in the early period and to reduce mortality and morbidity by earlier intervention.
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Background: Acute bronchiolitis is one of the most common diseases of early childhood. There are many recent changes in the treatment of acute bronchiolitis. The aim of this study is to evaluate treatment approaches to acute bronchiolitis among clinicians and to observe compliance with clinical guidelines. Materials and Methods: Our study was designed as a multicenter cross-sectional descriptive study. A cohort of pediatric residents, fellows, and attendants were surveyed with a questionnaire including general and occupational characteristics of pediatricians and treatment choices in acute bronchiolitis. Results: A total of 713 questionnaires were collected. Most commonly applied treatment among pediatricians was inhaled salbutamol, followed by intravenous hydration, hypertonic saline, and inhaled steroid. Most commonly preferred treatment in the management of mild bronchiolitis was oral hydration and inhaled salbutamol in severe bronchiolitis. Conclusion: Although recent guidelines for the treatment of acute bronchiolitis does not support the use of many different therapies, pediatricians still tend to use them, especially bronchodilators, corticosteroids, and antibiotics.
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We compared the effects of distilled water and normal saline as diluents for the endobronchial administration of epinephrine in anesthetized dogs by using a cross-over design. Six dogs received 2 mL of either normal saline or distilled water into the bronchus, and the other solution was administered 1 wk later. Eight dogs received 0.02 mg/kg epinephrine diluted in either distilled water (E + water) or normal saline (E + saline) to a total volume of 2 mL into the bronchus, and the other solution was administered 1 wk later. Normal saline or distilled water without epinephrine did not affect the plasma epinephrine concentration, mean arterial pressure (MAP), and Pao2. The peak plasma epinephrine concentration was significantly larger after treatment with E + water (26.5 ± 7.9 ng/mL) than after E + saline (2.1 ± 0.7 ng/mL). E + water caused an increase in MAP of 91 ± 24 mm Hg, whereas E + saline did not affect MAP. The maximal decrease in Pao2 after the administration of E + water (14 ± 5 mm Hg) was significantly greater than after E + saline (7 ± 2 mm Hg). In conclusion, distilled water as the diluent for endobronchially administered epinephrine to a total volume of 2 mL allowed better absorption of epinephrine compared with normal saline without a serious detrimental effect on Pao2. Implications Using a small volume of distilled water as the diluent for endobronchial epinephrine administration significantly increased epinephrine absorption and arterial pressure in comparison with normal saline, without having a serious detrimental effect on Pao2, in an anesthetized, noncardiopulmonary, resuscitation dog model.
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Saline water
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