The purpose of this study is to assess whether children with moderate to severe
bronchiolitis treated with standard racemic epinephrine therapy via 70:30 helium-oxygen
(heliox) driven nebulization will have improvements in measurements of airway more rapidly
than those treated with conventional air-oxygen driven nebulization.
- Any child 2-12 months old seen in the emergency department.
- A clinical bronchiolitis score > 3 by modified Wood's Clinical Bronchiolitis Score
- Diagnostic criteria of bronchiolitis includes tachypnea, cough, prolonged expiratory
phase, wheezing, rales, chest retractions, and hyperinflation of lungs on chest
radiograph. After consenting a patient to the study, respiratory syncytial virus
(RSV) infection will be tested by rapid enzyme-linked immunoabsorbent assay of nasal
- No child will be excluded based on race or gender
- Patients under the age of 2 months or greater than 12 months
- Patients with cyanotic heart disease
- Patients with lobar pneumonia, defined by results of chest radiographs.
- The presence of interstitial disease or diffuse patchy marking consistent with
atelectasis on chest radiographs will not exclude patients.
- Patients with croup.
- Patients with foreign body aspiration.
- Patients with history of cystic fibrosis, bronchopulmonary dysplasia or other chronic
- Patients with liver or renal disease.
- Patients with sickle cell anemia.
- Patients requiring mechanical ventilation.
- Patients who develop supraventricular tachycardia secondary to racemic epinephrine
- Patients with tracheomalacia or bronchomalacia.
- Patients who had received bronchodilators within 2 hours of initiation of the study.
- Patients who had received systemic corticosteroids within 72 hours of enrollment
- Patients who suffered from persistent airway hyperreactivity in the 3 months before
- Patients who do not tolerate the nasal cannulae for 45 out of 60 minutes.
In K Kim, MD
University of Louisville, Dept. of Pediatrics, Div. of Pediatric Emergency Medicine