How long should patients who receive nebulized racemic epinephrine for croup be observed?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Patients who receive nebulized racemic epinephrine in the emergency department should be observed for at least 3 hours post last treatment because of concerns for a return of bronchospasm, worsening respiratory distress, and/or persistent tachycardia. Patients can be discharged home only if they demonstrate clinical stability with good air entry, baseline consciousness, no stridor at rest and have received a dose of corticosteroids.

A study by Bagwell et al compiled information on 95,403 croup patients, ages 0 to 11 years, from the Pediatric Health Information System (2004-2014). These patients were initially evaluated and treated in various pediatric emergency departments (EDs) over this 10-year period. Their data analyses found that patients who received corticosteroids and single-dose nebulized epinephrine were managed differently from those who required multidose nebulized epinephrine. Patients who were treated with corticosteroids and multidose nebulized epinephrine, and subsequently discharged from the ED, were less likely to return for further care; however, if discharge from the ED did not occur, these patients were hospital-admitted at a higher rate when compared to patients receiving a single-dose nebulized epinephrine treatment in the ED setting. [38]

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