Aerosolized L-epinephrine vs budesonide for post-extubation stridor: A randomized controlled trial

• Published in: Indian pediatrics Vol. 47; no. 4; pp. 317 - 322
• Main Authors: Sinha, A., Jayashree, M., Singhi, S.
• Format: Journal Article
• Language: English
• Published: India Springer-Verlag 01.04.2010
• Subjects: Administration, Inhalation; Aerosols - administration & dosage; Aerosols - therapeutic use; Bronchodilator Agents - administration & dosage; Budesonide - administration & dosage; Child; Child, Preschool; Epinephrine - administration & dosage; Female; Humans; Infant; Intubation, Intratracheal - adverse effects; Male; Maternal and Child Health; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Research Paper; Respiration Disorders - drug therapy; Respiration Disorders - etiology; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Respiratory Sounds - drug effects; Respiratory Sounds - etiology; Epinephrine; Stridor; Budesonide; Extubation
• ISSN: 0019-6061; 0974-7559
• DOI: 10.1007/s13312-010-0060-z

Objective To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation stridor. Study design Randomized controlled trial. Setting Pediatric intensive care unit (PICU) of a tertiary teaching and referral hospital. Subjects Sixty two patients with a stridor score ≥4 following extubation. Intervention Patients were randomized to receive either aerosolized L-epinephrine ( n =32) or budesonide ( n =30). Respiratory rate, heart rate, stridor score, blood pressure and oxygen saturation were recorded from 0 min to 24 hours. Outcome measures Stridor score remaining at ≥4, need for re-nebulization and re-intubation between 20 min −24 hours were primary outcome measures. Tachycardia (HR > normal for age), hypertension (BP >95th centile for age) and hypoxia (SpO2 <92% for 5 min) were secondary outcome measures. Results Both drugs showed a significant and comparable decline in the median (95% CI) stridor scores from baseline to 60 min [4 (4.10–4.50) to 2.00 (1.46–2.67) for budesonide vs 4 (4.12–5.00) to 2.00 (1.31–2.75) for epinephrine]. At 2 hours, the stridor scores were significantly lower in the epinephrine as compared to budesonide group [0.00 (0.69–1.81) vs 3.00(1.75–3.32); P =0.02)]. However, the proportion of patients with stridor score ≥4 at any time between 20min–24 hrs (53.3% vs 53.1%; P =0.99), need for renebulization (40 % vs 43.8 %; P =0.76) and re-intubation (20% vs 25%, P =0.638), and adverse effects were similar in both groups. Conclusions Both aerosolized L-epinephrine and budesonide were equally effective in their initial therapeutic response in post-extubation stridor. However, epinephrine showed a more sustained effect.