Aerosolized L epinephrine vs Budesonide for Postextubation Stridor A Randomized Controlled Trial.

Author(s): Sinha A, Jayashree M, Singhi S

Affiliation(s): Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Correspondence to: Dr Jayashree Muralidharan, Additional Professor of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh 160 012, India. mjshree@hotmail.com.

Publication date & source: 2009-09-03, Indian Pediatr., [Epub ahead of print]

Publication type:

Objective: To compare the efficacy and adverse effects of aerosolized Lepinephrine vs budesonide in the treatment of postextubation stridor. Study design: Randomized controlled trial. Setting: Pediatric intensive care unit (PICU) of a tertiary teaching and referral hospital. Subjects: Sixty two patients with a stridor score >lowing extubation. Intervention: Patients were randomized to receive either aerosolized Lepinephrine (n=32) or budesonide (n =30). Respiratory rate, heart rate, stridor score, blood pressure and oxygen saturation were recorded from 0 min to 24 hours. Outcome measures: Stridor score remaining at >4, need for re-nebulization and reintubation between 20 min - 24 hours were primary outcome measures. Tachycardia (HR >normal for age), hypertension (BP >95th centile for age) and hypoxia (SpO2 < cnt; for 5 min) were secondary outcome measures. Results: Both drugs showed a significant and comparable decline in the median (95% CI) stridor scores from baseline to 60 min [4 (4.10 - 4.50) to 2.00 (1.46 - 2.67) for budesonide vs 4 (4.12 -5.00) to 2.00 (1.31 - 2.75) for epinephrine]. At 2 hours, the stridor scores were significantly lower in the epinephrine as compared to budesonide group [0.00 (0.69 -1.81) vs 3.00(1.75-3.32); P=0.02)]. However, the proportion of patients with stridor score >4 at any time between 20min -24 hrs (53.3% vs 53.1%; P=0.99), need for renebulization (40% vs 43.8% P=0.76) and re-intubation (20% vs 25%, P=0.638), and adverse effects were similar in both groups. Conclusions: Both aerosolized Lepinephrine and budesonide were equally effective in their initial therapeutic response in postextubation stridor. However, epinephrine showed a more sustained effect.