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Lee, Jin Hee,Jung, Jae Yun,Lee, Hyun Jung,Kim, Do Kyun,Kwak, Young Ho,Chang, Ikwan,Kwon, Hyuksool,Choi, Yoo Jin,Park, Joong Wan,Paek, So Hyun,Cho, Jun Hwi Elsevier 2019 The American journal of emergency medicine Vol.37 No.12
<P><B>Abstract</B></P> <P><B>Objective</B></P> <P>Croup treatment usually involves a single dose of systemic dexamethasone combined with nebulized epinephrine. However, the optimal dose of <SMALL>L</SMALL>-epinephrine remains unclear. We examined whether a low dose (0.1 mg/kg) was inferior to the conventional dose (0.5 mg/kg) of 1:1000 nebulized <SMALL>L</SMALL>-epinephrine in patients with moderate to severe croup.</P> <P><B>Methods</B></P> <P>This randomized double-blind clinical non-inferiority trial was conducted in three pediatric emergency departments from May 2015 to October 2017. Children 6 months to 5 years old with moderate to severe croup (Westley scale scores 3–11) were eligible. Subjects were randomly assigned to the conventional dose (0.5 mg/kg: maximum 5 mg) or low dose (0.1 mg/kg; maximum 1 mg) group. All subjects received 0.6 mg/kg dexamethasone. Croup scores and other vital signs were measured before and at 30, 60, 90, and 120 min after nebulized <SMALL>L</SMALL>-epinephrine administration. The primary outcome was the change in croup score after 30 min.</P> <P><B>Results</B></P> <P>The final analysis included 84 patients. The groups did not differ significantly in terms of demographic parameters. At 30 min after treatment with nebulized <SMALL>L</SMALL>-epinephrine, the croup scores in both groups were significantly reduced from the baseline values (<I>p</I> < 0.05) and did not differ between the two groups (<I>p</I> = 0.42). Neither blood pressure nor heart rate differed between the two groups.</P> <P><B>Conclusions</B></P> <P>Low-dose 1:1000 <SMALL>L</SMALL>-epinephrine was not inferior in croup score reduction to the conventional dose in patients with moderate to severe croup.</P> <P>Clinical trial No: NCT01664507, KCT0002318.</P>