Aerosolized L-epinephrine vs budesonide for post-extubation stridor: A randomized controlled trial

Abstract

Objective

To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation 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 ≥4 following extubation.

Intervention

Patients were randomized to receive either aerosolized L-epinephrine (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 re-intubation between 20 min −24 hours were primary outcome measures. Tachycardia (HR > normal for age), hypertension (BP >95th centile for age) and hypoxia (SpO2 <92% 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 L-epinephrine and budesonide were equally effective in their initial therapeutic response in post-extubation stridor. However, epinephrine showed a more sustained effect.