Croup: low-dose L-epinephrine is noninferior to standard dose


  • International Clinical Digest
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Takeaway

  • Children with croup improved about as well with a reduced L-epinephrine dose as with a standard dose in this small trial.

Why this matters

  • Previous dose studies were conducted in a population with postextubation stridor.
  • A smaller effective dose would presumably curb drug-related climbs in heart rate and BP.

Key results

  • Change in croup score, low- vs standard-dose groups: −1.85 (±1.08) vs −2.08 (±1.53) (95% CI, −0.36 to 0.82; P=.420).
  • Groups also had similar BPs, heart rates, admission rates, and emergency department (ED) return rates.
  • No side effects attributed to epinephrine in either group.

Study design

  • Randomized controlled double-blind trial at the pediatric EDs of 3 teaching hospitals (n=84).
  • Children aged 6 months to 5 years with moderate-to-severe croup were randomly assigned to low-dose (0.1 mg/kg, maximum 1 mg) vs standard-dose (0.5 mg/kg, maximum 5 mg) nebulized 1:1000 L-epinephrine.
  • All also received dexamethasone.
  • Outcome: 30-minute change in Westley croup score.
  • Funding: National Research Foundation of Korea.

Limitations

  • Low-dose group mean croup score was better than standard-dose group score at baseline (3.68±0.84 vs 4.30±1.24; P=.012).
  • Few patients had severe croup.