Helium/Oxygen Improves Clinical Scores in the Treatment of Children with Bronchiolitis
Session VII: Kim, I.K.
Title of Contribution: Helium/Oxygen Improves Clinical Scores in the Treatment of Children with Bronchiolitis
Author(s): In K. Kim1, Erin Phrampus2, Kendra Sikes1, Tim Corcoran4, Ed Gracely3, Al Saville5, Shekhar Venkataraman5
Affiliation(s):
1. Dept. of Pediatrics, Kosair Children's Hospital, Louisville, KY, USA.
2. Dept. of Pediatrics, Children’s Hospital of Pittsburgh , Pittsburgh, PA, USA.
3. Dept. of Community and Preventive Medicine, Drexel University College of Medicine , Philadelphia, PA, USA.
4. Dept. of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
5. Dept. of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Abstract:
Introduction : Bronchiolitis has few effective therapies.
Hypothesis: Nebulized racemic epinephrine delivered by 70%:30% helium/oxygen (HE) followed by inhalation HE therapy via nasal cannula will result in a greater degree of clinical improvement compared to that delivered by 100% oxygen (OX).
Methods : A convenience sample was enrolled in this prospective, randomized, single-blind trial. Children were 2-12 months old with bronchiolitis. Patients were enrolled if they had a Modified Wood's Clinical Bronchiolitis Score (M-WCBS) > 3 after receiving a nebulized albuterol treatment. Patients were randomized to nebulized racemic epinephrine delivered by either HE or OX using a non-rebreathing face mask. After nebulization, the randomized gas was inhaled via a nasal cannula. After the first 60 minutes of inhalation therapy, patients who had a M-WCBS score > 2 received a second dose of nebulized racemic epinephrine. Then, the randomized gas was inhaled via a nasal cannula. The main outcome measure was degree of improvement of M-WCBS scores over 240 minutes (at 60 minute intervals) or until ED discharge.
Results : Of the 69 children enrolled, 34 (49%) were randomized to the HE group and 35 (51%) were randomized to the OX group. The mean change in M-WCBS score from baseline to 240 minutes or ED discharge was 1.84 for the HE group compared with 0.31 for the OX group (p < 0.001). In addition, the mean M-WCBS was significantly improved for the HE group compared to the OX group at 60 minutes (p=0.005), 120 minutes (p<0.001), and 180 minutes (p<0.001).
Conclusions : Nebulized racemic epinephrine delivered by HE followed by inhalation HE therapy delivered by nasal cannula was associated with a greater degree of clinical improvement compared to that delivered by OX among children with bronchiolitis.
