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Publications

Journal Article Epublish

PubMed: 41602279 DOI: 10.1097/CCE.0000000000001368

Inhaled L-Epinephrine As a Rescue Therapy in Critical Bronchiolitis.

Crit Care Explor 8(2):e1368

Authors: Daniel Nigri, Meredith C Winter, Patrick A Ross, Ruiqi Huang, Justin C Hotz, Cristina Castro, Anoopindar Bhalla, Christopher J L Newth

Affiliations

  • Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. Department of Critical Care Medicine, Le Bonheur Children's Hospital, Memphis, TN. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.
  • Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
  • Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
  • Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA.

Abstract

IMPORTANCE

Viral bronchiolitis is the leading cause of nonelective admission to the PICU. Guidelines recommend management that focuses on supportive care. Evidence suggests that inhaled epinephrine may reduce lower airways resistance and work of breathing in critical bronchiolitis. It has been demonstrated at one institution that it is feasible to administer continuous inhaled epinephrine (CIE) via heated high-flow nasal cannula (HFNC).

OBJECTIVES

To describe the demographic and clinical characteristics of patients with bronchiolitis who received CIE and assess their physiologic response to treatment compared with patients who received conventional therapy.

DESIGN SETTING AND PARTICIPANTS

We performed a single-center retrospective cohort study of previously healthy children 0-2 years old admitted to the PICU with diagnosis of bronchiolitis from 2017 to 2023.

MAIN OUTCOMES AND MEASURES

Physiologic response to treatment was assessed via analysis of vital signs and use of respiratory rate, oxygenation, heart rate (ROX-HR) index.

RESULTS

One hundred ninety-three patients were included in the study. Patients who received CIE were younger (median age, 4 vs. 7 mo old; p = 0.01) and smaller (7.0 vs. 8.4 kg; p = 0.06), presented with higher initial peak respiratory rates (70 vs. 50 beats/min; p < 0.0001), and had longer ICU stays (3.4 vs. 1.8 d; p < 0.001). Patients treated with CIE exhibited overall higher respiratory rates and lower ROX-HR indices, indicating more severe illness. Within the first 48 hours of treatment, patients receiving CIE demonstrated a more rapid improvement in both respiratory rate and ROX-HR index compared with those receiving conventional therapy.

CONCLUSIONS AND RELEVANCE

In this cohort, CIE was used as novel therapy for younger, smaller patients with more severe bronchiolitis on presentation to the PICU. The physiologic changes suggest potential benefit of this therapy for patients who are not improving with conventional HFNC therapy.

MeSH

Epinephrine, Therapeutics, Respiratory Rate, Bronchiolitis, Cannula