[The safety of nebulization with 3 to 5 ml of adrenaline (1:1000) in children: an evidence based review]

Abstract

Objective: To present the evidence regarding the safety of nebulization with 3-5 ml of adrenaline (1:1000) for the treatment of children with acute inflammatory airway obstruction.

Sources of data: An electronic search was undertaken, using mainly Medline databases (January of 1949-July of 2004). The study inclusion criteria for this review were: 1) randomized clinical trial; 2) Patients (up to 12 yrs) with diagnosis of bronchiolitis or laryngotracheobronchitis; 3) use of adrenaline (1:1000) by nebulization. The principal data extracted from the trials included adrenaline dosages and their effects on heart rate and blood pressure and any other side-effects.

Summary of the findings: Seven clinical trials with a total of 238 patients were included for this review. Two of the five trials in which larger dosages (> or = 3 ml) of adrenaline were used demonstrated a significant increase in heart rate. The mean increase in heart rate varied from seven to 21 beats per minute, up to 60 minutes after treatment. The highest incidence of pallor was observed in one trial with 21 children treated by nebulization with 3 ml of adrenaline (47.6% in the adrenaline group vs. 14.3% in the salbutamol group, 30 minutes after treatment). Two clinical trials failed to observe a significant effect on blood pressure from nebulization with adrenaline (4 and 5 ml).

Conclusion: Evidence shows that nebulization with 3 to 5 ml of adrenaline (1:1000) is a safe therapy, with minor side-effects, for children with acute inflammatory airway obstruction.