None listed
Conditions
Brief summary
The DAB study (ACTRN12613000316707) was a pragmatic, randomised study of corticosteroids and nebulised adrenaline in children with bronchiolitis admitted to intensive care. It showed that, compared to standard care alone, the combination of steroids and nebulised adrenaline reduced the duration of positive pressure respiratory support (PPS). The evidence was particularly strong in the sickest children requiring, continuous positive airway pressure (CPAP) and mechanical ventilation (MV), and those who had Respiratory Syncytial Virus (RSV) infection. Chest hyperinflation is a common clinical sign in children with severe bronchiolitis. It occurs because of lower airway obstruction during expiration and subsequent gas trapping in the lung. Chest hyperinflation can be identified clinically but it is also a chest x-ray finding with varying severity. Chest x-ray findings include, flattened hemidiaphragms, an increased number of rib markings and widened intercostal spaces. Children with bronchiolitis and hyperinflation may be more responsive to the bronchodilator effects of combination corticosteroid and adrenaline therapy compared to those without hyperinflation. Moreover, hyperinflation may be associated with RSV infection, and the presence of hyperinflation in this group may explain the strong effect of steroids and adrenaline. We hypothesise that the degree of hyperinflation predicts the response to steroids and adrenaline on duration of PPS in children with bronchiolitis. We also hypothesise that hyperinflation is associated with the presence of RSV infection. The primary aim of this study is to investigate whether chest hyperinflation, based on x-ray findings, predicts the response to corticosteroids and inhaled adrenaline on the duration of positive pressure support in children enrolled in the DAB study. The secondary aims are to investigate whether chest hyperinflation predicts the presence of RSV and human metapneumovirus or other viruses, and to assess the concordance between radiologists of their assessment of the degree of hyperinflation.
Interventions
Children who participated in the DAB study (ACTRN12613000316707) will be the population for the current study. There will be no active participation from children in the current study. Only demographic, clinical and outcome data will used from the previous linked study. In the DAB study patients in the treatment group received either 0.6 mg/kg dexamethasone intramuscularly or intravenously OR 4mg/kg of oral prednisolone as a loading dose, then 1 mg/kg of methylprednisolone intravenously or predn
Children who participated in the DAB study (ACTRN12613000316707) will be the population for the current study. There will be no active participation from children in the current study. Only demographic, clinical and outcome data will used from the previous linked study. In the DAB study patients in the treatment group received either 0.6 mg/kg dexamethasone intramuscularly or intravenously OR 4mg/kg of oral prednisolone as a loading dose, then 1 mg/kg of methylprednisolone intravenously or prednisolone nasogastrically or orally 8 hourly for 9 doses (days 1-3 of the study), then daily for three days (days 4-6). In addition nebulised adrenaline was administered to those in the treatment arm; five half hourly doses followed by one to 4 hourly doses. Standard care (nutrition, respiratory support and sedation) were provided to children in both arms of the study. Children who participated in the DAB study (ACTRN12613000316707) and had chest xrays performed at the time of the trial will be the subjects of the current study. Chest xrays will be retrieved and scored for evidence of hyperinflation to determine if the trial interventions were associated with an effect on the primary outcome based on the degree of hyperinflation
Sponsors
Royal Children's Hospital
Eligibility
Sex/Gender
All
Age
0 to 18 Months
Healthy volunteers
No
Inclusion criteria
Children who were recruited in the DAB study (ACTRN12613000316707) and received a chest x ray The inclusion criteria were a clinical diagnosis of bronchiolitis, defined as a first or second episode of wheezing or respiratory distress associated with a respiratory tract infection plus either radiological evidence of chest hyperinflation or clinical evidence of prolonged expiration • less than 18 months of age • no previous enrolment to this study • admission to intensive care for respiratory distress (not apnoea alone) • recruitment and initiation of the study therapy within 4 hours of admission to intensive care
Exclusion criteria
Patients with the following will be excluded • Corrected gestational age of less than 37 weeks at time of admission to the intensive care. • Clinical evidence of croup (laryngotracheobronchitis) • Received immunosuppressive treatment, including any dose of corticosteroids, in the last 7days. • On ECMO or HFOV at the time of enrolment • Previously enrolled in the study
Outcome results
None listed