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A Meta-analysis of Randomized Controlled Trials Evaluating the Efficacy of Epinephrine for the Treatment of Acute Viral Bronchiolitis
Lisa Hartling, BScPT, MSc;
Natasha Wiebe, MMath;
Kelly Russell, BSc;
Hema Patel, MD, MSc, FRCPC;
Terry P. Klassen, MD, MSc, FRCPC
Arch Pediatr Adolesc Med. 2003;157:957-964.
Background Controversy exists surrounding the use of bronchodilators for bronchiolitis. Epinephrine hydrochloride is being used with increasing frequency in this group; however, its efficacy has not been systematically reviewed.
Objective To systematically review randomized controlled trials comparing inhaled or systemic epinephrine vs placebo or other bronchodilators.
Data Sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, primary authors, and reference lists.
Study Selection Studies were included if they (1) were randomized, controlled trials; (2) involved children 2 years or younger with bronchiolitis; and (3) presented quantitative outcomes.
Data Extraction Two reviewers independently extracted data and assessed study quality.
Data Synthesis We included 14 studies (7 inpatient, 6 outpatient, and 1 patient status unknown). Thirteen of forty-five comparisons were significant. Among outpatients, results favored epinephrine compared with placebo for clinical score at 60 minutes (standardized mean difference [SMD], -0.81; 95% confidence interval [CI], -1.56 to -0.07), oxygen saturation at 30 minutes (weighted mean difference [WMD], 2.79; 95% CI, 1.50-4.08), respiratory rate at 30 minutes (WMD, -4.54; 95% CI, -8.89 to -0.19), and improvement (odds ratio, 25.06; 95% CI, 4.95-126.91); among inpatients, for clinical score at 60 minutes (SMD, -0.52; 95% CI, -1.00 to -0.03). Among outpatients, results favored epinephrine compared with albuterol sulfate (salbutamol) for oxygen saturation at 60 minutes (WMD, 1.91; 95% CI, 0.38-3.44), heart rate at 90 minutes (WMD, -14.00; 95% CI, -22.95 to -5.05), respiratory rate at 60 minutes (WMD, -7.76; 95% CI, -11.35 to -4.17), and improvement (odds ratio, 4.51; 95% CI, 1.93-10.53); among inpatients, respiratory rate at 30 minutes (WMD, -5.12; 95% CI, -6.83 to -3.41).
Conclusions Epinephrine may be favorable compared with placebo and albuterol for short-term benefits among outpatients. There is insufficient evidence to support the use of epinephrine among inpatients. Large, multicentered trials are required before routine use among outpatients can be strongly recommended.
From the Alberta Research Center for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton (Mss Hartling, Wiebe, and Russell and Dr Klassen); and the Department of Pediatrics, McGill University Health Centre, Montreal, Quebec (Dr Patel).
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