Efficacy of Budesonide, Epinephrine and Salbutamol Inhalation for Treatment of Transient Tachypnea of Newborn: Prospective Controlled Study

Background: Transient tachypnea of the newborn (TTN) is a neonatal lung disease which has a picture of lung edema due to delayed resorption of lung fluids. It is commonly seen in full-term or late-preterm in­fants with an occurrence rate of 5.7 in 1,000 infants. The aim of this work was to compare the efficacy of inhaled budesonide, epinephrine and salbutamol for treatment of TTN. Methods: This prospective controlled study was conducted on a100 full term neonates with presumed diagnosis of TTN. They were randomly assigned into four groups equally. Group I received nebulized budesonide, Group I received nebulized epinephrine, Group III received nebulized salbutamol and Group IV received nebulized normal saline. Results: Salbutamol significantly decreased respiratory rate and TTN clinical score, duration of respiratory support along with hospitalization time and helped with reaching full feeding earlier compared to other groups. Conclusions: Inhaled salbutamol significantly decreased TTN clinical score, shorter duration of respiratory support, hospitalization and earlier initiation of enteral feeding compared to placebo. Inhaled budesonide and epinephrine did not significantly reduce the duration of oxygen treatment, with no other significant effect on TTN.

Management of a Patient With Tracheal Stenosis After Previous Tracheotomy

Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.

A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis

Background: Acute Bronchiolitis is an infection of the lower respiratory tract, most frequently caused by the respiratory syncytial virus. It is one of the most common cause of hospital admission for respiratory tract illnesses in infants. This is a double blinded randomized controlled trial, conducted to compare the therapeutic efficacy of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis.Methods: It was a double blinded randomized controlled trial conducted over a period of 18 months (January 2019-June 2020) in infants aged 2 months to 1 year diagnosed with acute bronchiolitis. All eligible patients were randomly assigned to one of two groups: Group I received inhalation of Epinephrine; Group II received inhalation of Hypertonic (3%) Saline. Patients in each group received four treatments on each day of hospitalization, delivered at 6 hourly intervals. Monitoring parameters for improvement or worsening of the condition were measured and recorded on admission and then at 24 hourly intervals using the clinical score described by Wang, et al for the first three days of treatment.Results: Among the infants treated with hypertonic saline, there was a significant decrease in the post inhalation respiratory score on day 2 and day 3 as compared to the infants treated with epinephrine. There was a significant difference in duration of hospitalization between the two groups as duration of hospitalization in infants was less in hypertonic saline group as compared to the epinephrine group. Hypertonic saline also showed significantly lesser side effects post inhalation when compared to epinephrine. The difference was statistically significant with p<0.0001.Conclusions: The study concluded that the use of nebulized hypertonic saline in infants aged 2 months to 12 months, provides evidence for its role as an efficient treatment modality in the treatment of acute bronchiolitis. The study also found that nebulized epinephrine had more side effects associated with it.

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: a systematic review and meta-analysis

Management of acute bronchiolitis remains controversial due to lack of strong evidence-based data. Nebulized epinephrine and hypertonic saline have been studied in infants with bronchiolitis, with conflicting results. This systematic review and meta-analysis aimed to evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO2) and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized. 18 trials were systematically selected and 16 of them contributed for the meta-analysis (1,756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of – 0.35 days, 95% CI -0.62 to -0.08, p = 0.01, I2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 hours and 72 hours after the admission (SMD of -0.35, 95% CI -0.62 to -0.09, p = 0.008, I2 = 41% and SMD of -0.27, 95% CI -0.50 to -0.04, p = 0.02, I2 = 0%, respectively). No difference in SaO2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient. In conclusion, nebulized epinephrine plus HS may be considered as a safe, cheap and efficient alternative for decreasing LOS and CSS in infants with acute bronchiolitis, especially on those who require more than 48 hours of hospitalization.

Nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis: Single Center Study.

Objectives: To compare the outcome of nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis. Study Design: Randomized Controlled Trial. Setting: Department of Pediatrics, Federal Government Polyclinic Hospital, Islamabad. Period: 6 month (1st October, 2016 to 1st April, 2017). Material & Methods: Children fulfilled selection criteria were enrolled. Then patients were randomly divided in two groups by using lottery method. In Group A, children received salbutamol. In group B, children received nebulized adrenaline. After 48 hours, children were evaluated for heart rate, respiratory rates, oxygen saturation and Respiratory Distress Assessment Index (RDAI) score. All the information was collected using proforma. Data was analyzed using SPSS version 21. Results: The mean age of children was 10.45±6.70 months in epinephrine group and13.07±6.28 months in salbutamol group. There were 29 (52.7%) males & 26 (47.3%) females in both groups. After 48 hours, mean heart rate was 122.58±4.75bpm with epinephrine while 127.87±4.4.44bpm with salbutamol. Mean respiratory rate was 35.16±3.29bpm with epinephrine while 39.84±3.32bpm with salbutamol. Mean RDAI score was 8.35±1.36 with epinephrine while 10.07±1.37 with salbutamol. Mean oxygen saturation was 85.24±2.74% with epinephrine while 80.38±3.26% with salbutamol. The difference was significant (P<0.05). Conclusion: Thus the nebulized epinephrine was found to be more effective in maintaining heart rate, respiratory rate, oxygen saturation and RDAI score of children as compared to salbutamol.

Preclinical and clinical studies of smoke-inhalation-induced acute lung injury: update on both pathogenesis and innovative therapy

Smoke-inhalation-induced acute lung injury (SI-ALI) is a leading cause of morbidity and mortality in victims of fire tragedies. SI-ALI contributes to an estimated 30% of burn-caused patient deaths, and recently, more attention has been paid to the specific interventions for this devastating respiratory illness. In the last decade, much progress has been made in the understanding of SI-ALI patho-mechanisms and in the development of new therapeutic strategies in both preclinical and clinical studies. This article reviews the recent progress in the treatment of SI-ALI, based on pathophysiology, thermal damage, airway obstruction, the nuclear-factor kappa-B signaling pathway, and oxidative stress. Preclinical therapeutic strategies include use of mesenchymal stem cells, hydrogen sulfide, peroxynitrite decomposition catalysts, and proton-pump inhibitors. Clinical interventions include high-frequency percussive ventilation, perfluorohexane, inhaled anticoagulants, and nebulized epinephrine. The animal model, dose, clinical application, and pharmacology of these medications are summarized. Future directions and further needs for developing innovative therapies are discussed. The reviews of this paper are available via the supplementary material section.