A small RCT (31 children, 6 months to 6 years of age) demonstrated L-epinephrine [1:1000] to be as effective and well tolerated as racemic epinephrine in moderate to severe croup.
In a retrospective study of 50 children with croup who were given aerosolized racemic epinephrine and observed in the ED for 2 hours after treatment, 58% received steroids
Human blood pressure and pulse rate response to racemic epinephrine
The positive response rate to inhaled racemic epinephrine
was significantly higher at 54,3% among premature infants, compared with 28% among full-term infants (P = .
The patients were randomized to nebulized racemic epinephrine delivered either by heliox (70% helium/30% oxygen) or 100% oxygen using a face mask.
After 60 minutes of treatment, children whose bronchiolitis scores were 2 or higher received another dose of the nebulized racemic epinephrine, followed by continued inhalation via nasal cannula.
Unscheduled returns were defined as the subsequent need for additional steroids, racemic epinephrine
, and/or hospitalization.
Herrington's empirical experience, controlled, double-blinded studies of [beta]-adrenergics, racemic epinephrine
, and adrenaline demonstrate that these agents provide only minimal clinical benefit (over a range of dosages).
54] A study by Kristjansson et al found that nebulized racemic epinephrine
(a mixture of D- and L- isomers) is superior to placebo at increasing oxygenation, with the best response in those children with baseline Sa[O.
Nebulized racemic epinephrine
should be used along with the steroid dose in those children with significant stridor at rest, decreased air entry, and retractions.
Three therapeutic modalities are available for the treatment of croup: humidified air, racemic epinephrine
, and adrenal corticosteriods.