Abstract
Although AE is commonly used in treating post intubation LE, the efficacy and side effects of this therapy in pediatric patients (pts) have not been studied. We, therefore, undertook this study to assess AE therapy in postintubation stridor in a Pediatric Intensive Care Unit (PICU). Pts with a previous history of stridor were excluded. Following extubation, pts demonstrating clinically significant stridor and a croup score (CS) > 4 points received AE. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), and CS were recorded at 20, 40 and 60 min and 4 hrs. Additional AE was administered as needed. Pts were followed until discharged from the PICU. The diagnoses, duration of intubation, admission TISS score and outcome were also recorded. We studied 27 pts, aged 1 to 36 mths. Diagnosis was airway disease in 26% and lung disease in 22%. Mean duration of intubation was 5.8±5 days and mean TISS 38±19. Post extubation stridor developed within 38±51 min. Initial CS was 6.8±2.9, and best score achieved with AE within 60 min was 2.9±2.3 (p<0.01). CS at 4 hrs was 20±2.5. CS decreased by ≥2 points after AE in 23 pts (85%). Those that did not improve had initial CS of 7.5±5.7 (not different from the overall group). Four pts needed reintubation, but in only one was this felt to be due to LE. 14 pts (54%) required 2 or more additional AE. There were no significant differences in CS (7±2.6 vs 6.1±2.2), TISS (38±17 vs 34±23), or duration of intubation (6.6±5.9 vs 4.1±2.7) in pts requiring multiple AE vs those requiring only one additional AE. No significant change in HR or MAP following AE was seen. We conclude that AE is effective in treating symptomatic post-intubation LE. Duration of intubation, initial TISS and CS did not predict severity of LE, response to AE or need for additional AE. The efficacy and safety of AE in post-intubation LE make it a useful therapy in patients with this disorder.
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Nutman, J., Deakins, K., Baldesare, K. et al. PROSPECTIVE STUDY OF POST INTUBATION LARYNGEAL EDEMA (LE) TREATED WITH AEROSOLIZED EPINEPHRINE (AE). Pediatr Res 21 (Suppl 4), 205 (1987). https://doi.org/10.1203/00006450-198704010-00233
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DOI: https://doi.org/10.1203/00006450-198704010-00233