For a study, researchers sought to examine if the combination of systemic corticosteroids and nebulized epinephrine, as compared to conventional therapy, lowered the time of positive pressure support in children referred to critical care with bronchiolitis. Between July 2013 and November 2019, they conducted a pragmatic, multicenter, open-label, randomized experiment in children fewer than 18 months old with a clinical diagnosis of bronchiolitis. The intervention group received 13 mg/kg prednisolone over three days, then 1 mg/kg daily for three days, plus 0.05 mL/kg of nebulized 1% epinephrine made up to 6 mL with 0.9% saline via a jet nebulizer and mask using oxygen at 12 l/min every 30 minutes for five doses, then 1-4 hourly for three days, then as needed for three days. The key outcome was the duration of clinician-managed positive pressure support in critical care, which was defined as high-flow nasal-prong oxygen, nasopharyngeal continuous positive airway pressure, or mechanical ventilation.
Positive pressure was applied to 210 youngsters in total. Positive pressure support was given to 107 children in the corticosteroid–epinephrine group for a geometric mean of 26 (95% CI, 22-32) hours compared to 40 (95% CI, 34-47) hours in the control group, adjusted ratio 0.66 (95% CI 0.51-0.84), P=.001. In the intervention group, 41 (38%) of the children had at least one adverse event, compared to 39 (38%) in the control group. Regular therapy with systemic corticosteroids and inhaled epinephrine shortened the duration of clinician-managed pressure support in children with severe bronchiolitis compared to routine care.