Heliox-Driven Racemic Epinephrine Nebulization in Treatment of Moderate to Severe Bronchiolitis in Pediatric ED Patients

Inclusion Criteria:

- Any child 2-12 months old seen in the emergency department.

- A clinical bronchiolitis score > 3 by modified Wood's Clinical Bronchiolitis Score
(M-WCBS).

- 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
secretions.

Exclusion Criteria:

- 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
lung disease.

- Patients with liver or renal disease.

- Patients with sickle cell anemia.

- Patients requiring mechanical ventilation.

- Patients who develop supraventricular tachycardia secondary to racemic epinephrine
administration.

- 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
the study.

- Patients who do not tolerate the nasal cannulae for 45 out of 60 minutes.