- Use of a Clinical Guideline and Orderset to Reduce Hospital Admissions for Croup. [Review]Pediatrics. 2022 09 01; 150(3)Ped
- CONCLUSIONS: Croup quality improvement interventions were associated with a significant decrease in hospital admissions with no increase in revisits.
- Publisher Full Text (DOI)
- Prediction Model for Croup Admission Need. [Journal Article]Hosp Pediatr. 2022 08 01; 12(8):711-718.HP
- CONCLUSIONS: The croup admission need predictive model appears to support clinical decision making in the ED, with the potential to improve decision making when pediatric expertise is limited.
- Publisher Full Text (DOI)
- Two Case Reports of Life-Threatening Croup Caused by the SARS-CoV-2 Omicron BA.2 Variant in Pediatric Patients. [Case Reports]
- Croup is a common upper airway infection characterized by a barking cough, stridor, and hoarseness. It is usually caused by viral infection. A small number of croup caused by coronavirus disease 2019 (COVID-19) has been reported in children before the omicron variant surge. Previously reported cases indicated that croup caused by COVID-19 can be treated in the same manner as those with other vira…
- PMC Free PDF
- Retrospective Evaluation of Return Rates in Pediatric Patients Treated With Inhaled Racemic Epinephrine for Croup. [Journal Article]WMJ. 2022 Apr; 121(1):26-29.WMJ
- CONCLUSIONS: Based on our study results, we can conclude that observing patients following treatment of croup with inhaled racemic epinephrine in the ED for less than 2 hours did not increase their risk of deterioration or need to return. Our data did not show that a longer observation time resulted in lower return rates within 48 hours.
- Treatment for acute bronchiolitis before and after implementation of new national guidelines: a retrospective observational study from primary and secondary care in Oslo, Norway. [Journal Article]
- CONCLUSIONS: Implementation of the new guidelines on the treatment of acute bronchiolitis was successfully implemented in both primary and secondary care.
- PMC Free PDF
- Rate of Airway Intervention for Croup at a Tertiary Children's Hospital 2015-2016. [Journal Article]
- CONCLUSIONS: We found a low rate of IRE/IAI after ED management in patients with croup and no significant associations aside from preadmission RE doses. These findings may be considered in admission decisions.
- Publisher Full Text (DOI)
- Inpatient use of racemic epinephrine for children admitted with croup. [Journal Article]
- CONCLUSIONS: Patients hospitalized for croup with recent use of steroids prior to ED presentation have a greater need for > 2 RE during hospitalization. The majority who require inpatient RE will do so within 8-12 hours. These data provide information for risk stratification and duration of monitoring for patients hospitalized with croup.
- Publisher Full Text (DOI)
- Hospital Course of Croup After Emergency Department Management. [Multicenter Study]
- CONCLUSIONS: Less than one-quarter of children admitted to the general wards for croup received significant interventions after admission. Tachypnea in the ED and use of radiograph were associated with an increased use of significant interventions.
- PMC Free PDF
- Croup Admissions: Can We Shrink the Elephant in the Room? [Journal Article]Pediatr Emerg Care. 2021 Dec 01; 37(12):e940-e943.PE
- CONCLUSIONS: There appear to be promising predictors in croup patients presenting to the ED, which might help stratify risk for interventions after the ED encounter and thus reduce the number of potentially avoidable admissions.
- Publisher Full Text (DOI)
- Decreasing Racemic Epinephrine for Bronchiolitis in an Academic Children's Hospital. [Journal Article]
- CONCLUSIONS: Using a multidisciplinary approach and focused education techniques may be an effective way to reduce racemic epinephrine use for children with bronchiolitis.
- Publisher Full Text (DOI)
- Uncommon presentation of a common disease: influenza A presenting as adult croup . [Case Reports]
- An 88-year-old woman presented to our emergency room with complaints of fever, coryza, barking cough and generalised fatigue for 2 days. Physical examination showed stridor, tachypnoea with use of accessory muscles of respiration on admission. Laboratory tests were unremarkable except for monocytosis with a normal total white cell count. Rapid influenza diagnostic test was positive for influenza …
- PMC Free PDF
- National treatment guidelines decreased the use of racemic adrenaline for bronchiolitis in four Finnish university hospitals. [Multicenter Study]
- CONCLUSIONS: The current care guidelines for bronchiolitis had some impact on clinical practice, as the overall use of racemic adrenaline more than halved, but considerable differences remained in the four study hospitals after their publication.
- Publisher Full Text (DOI)
- Failure of Outpatient Management With Different Observation Times After Racemic Epinephrine for Croup. [Journal Article]Clin Pediatr (Phila). 2018 06; 57(6):706-710.CPed
- CONCLUSIONS: Patients requiring RE for croup are more likely to have treatment failure if observed for between 2.1 and 3 hours as opposed to 3.1 to 4 hours.
- Publisher Full Text (DOI)
- Inpatient Treatment after Multi-Dose Racemic Epinephrine for Croup in the Emergency Department. [Journal Article]
- CONCLUSIONS: Inpatient interventions after ≥ 2 ED doses of RE for croup were infrequent, most commonly RE administration. Most patients asymptomatic upon admission require 0-1 inpatient RE doses and may be candidates for outpatient management.
- Publisher Full Text (DOI)
- Steeple sign: a case of croup. [Case Reports]Adv Emerg Nurs J. 2015 Apr-Jun; 37(2):79-82.AE
- Croup, or laryngotracheobronchitis, is a common viral respiratory tract illness seen in the pediatric population (). This article describes the case of a child who presents with croup and the characteristic "steeple sign" seen on the radiograph. The patient received a diagnosis of croup secondary to the parainfluenza virus infection. It is imperative for advanced practice nurses to recognize the …
- Publisher Full Text (DOI)
- Subglottic laryngitis--Changes in therapy approach over the past 20 years. [Journal Article]
- CONCLUSIONS: Main novelties included the use of racemic epinephrine and downfall of antibiotic, antihistaminic and humidification therapy use, while corticosteroids remained the cornerstone in the treatment of moderately severe subglottic laryngitis. Differences between approaches among specialities are minimized during 20-year period.
- Publisher Full Text (DOI)
- Nonprescription racemic epinephrine for asthma. [Clinical Trial]
- CONCLUSIONS: RE provides less bronchoprotection from methacholine than does albuterol and may be less effective in treating acute bronchospasm.
- Publisher Full Text (DOI)
- Viral croup: diagnosis and a treatment algorithm. [Review]
- Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatmen…
- Publisher Full Text (DOI)
- The clinical management of preterm infants with bronchiolitis. [Journal Article]
- CONCLUSIONS: Management decisions among term and premature infants with bronchiolitis were similar. Premature infants who received albuterol were more likely to receive steroids; however, the decision regarding steroid use was not associated with documentation of efficacy of albuterol.
- Local facial cutaneous vasoconstriction: an unusual complication of inhaled racemic epinephrine in a neonate. [Case Reports]J Perinatol. 2013 Dec; 33(12):985-6.JP
- A term infant treated for post-extubation stridor with nebulized racemic epinephrine developed localized facial blanching due to cutaneous absorption of the aerosolized vasoconstrictor. Local application of heat restored circulation to the afflicted area. This complication of a commonly used medication is not previously reported in the medical literature and has the potential for severe sequelae.
- Publisher Full Text (DOI)
- On-demand, not scheduled, nebulization (epinephrine or saline) improves important clinical outcomes in hospitalized infants with bronchiolitis. [Comment]
- Aggregator Full TextAggregator Full TextPublisher Full Text
- Nebulized epinephrine for croup in children. [Review]
- CONCLUSIONS: Nebulized epinephrine is associated with clinically and statistically significant transient reduction of symptoms of croup 30 minutes post-treatment. Evidence does not favor racemic epinephrine or L-epinephrine, or IPPB over simple nebulization.The authors note that data and analyses were limited by the small number of relevant studies and total number of participants and thus most outcomes contained data from very few or even single studies.
- Publisher Full Text (DOI)
- Racemic adrenaline and inhalation strategies in acute bronchiolitis. [Randomized Controlled Trial]
- CONCLUSIONS: In the treatment of acute bronchiolitis in infants, inhaled racemic adrenaline is not more effective than inhaled saline. However, the strategy of inhalation on demand appears to be superior to that of inhalation on a fixed schedule. (Funded by Medicines for Children; ClinicalTrials.gov number, NCT00817466; EudraCT number, 2009-012667-34.).
- Publisher Full Text (DOI)
- Helium-oxygen therapy for infants with bronchiolitis: a randomized controlled trial. [Randomized Controlled Trial]
- CONCLUSIONS: Nebulized racemic epinephrine delivered by helium-oxygen followed by helium-oxygen inhalation therapy delivered by HFNC was associated with a greater degree of clinical improvement compared with that delivered by oxygen among infants with bronchiolitis. Trial Registration clinicaltrials.gov Identifier: NCT00116584.
- Aggregator Full TextPublisher Full Text
- Labeling for bronchodilators to treat asthma; cold, cough, allergy, bronchodilator, and antiasthmatic drug products for over-the-counter human use. Final rule. [Journal Article]Fed Regist. 2011 Jul 26; 76(143):44475-89.FR
- The Food and Drug Administration (FDA) is amending the final monograph (FM) for over-the-counter (OTC) bronchodilator drug products to add additional warnings (e.g., an "Asthma alert'') and to revise the indications, warnings, and directions in the labeling of products containing the ingredients ephedrine, ephedrine hydrochloride, ephedrine sulfate, epinephrine, epinephrine bitartrate, racephedri…
- FREE Publisher Full Text
- Nebulized epinephrine for croup in children. [Review]
- CONCLUSIONS: NE is associated with clinically and statistically significant transient reduction of symptoms of croup 30 minutes post-treatment. Evidence does not favor racemic epinephrine or LE, or IPPB over simple nebulization.
- Publisher Full Text (DOI)
- A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. [Randomized Controlled Trial]
- CONCLUSIONS: In the treatment of acute bronchiolitis, hypertonic saline and epinephrine did not improve clinical outcome any more than normal saline and epinephrine in the emergency setting. This differs from previously published results of outpatient and inpatient populations and merits further evaluation.
- Aggregator Full TextPublisher Full Text
- A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. [Randomized Controlled Trial]
- CONCLUSIONS: Similar statistically significant bronchodilation occurred after all three bronchodilators as indicated by a decrease in peak inspiratory pressure and respiratory system resistance, but these changes were small and probably clinically insignificant. However, side effects of bronchodilators, such as tachycardia, also occurred, and these may be clinically significant. Thus the benefit of bronchodilator treatment in these patients is small, does not differ among the drugs we studied and of questionable value.
- Aggregator Full Text
- Comparison of nebulized epinephrine to albuterol in bronchiolitis. [Randomized Controlled Trial]
- CONCLUSIONS: In children up to the 18th month of life, ED treatment of bronchiolitis with nebulized racemic albuterol led to more successful discharges than nebulized epinephrine.
- PMC Free PDF
- Inhaled epinephrine for the treatment of transient tachypnea of the newborn. [Randomized Controlled Trial]
- CONCLUSIONS: We did not observe any adverse effects of inhaled racemic epinephrine when administered for the treatment of TTN. Larger studies are necessary to determine efficacy.
- Publisher Full Text (DOI)