Ben Gelbart

Keywords Sepsis Child Vasoconstrictor agents Epidemiology Critical care Evidence before this study Vasoactive agents are a critical component of haemodynamic support for children with sepsis and septic shock. Existing international guidelines, including those from the Surviving Sepsis Campaign, recommend the early initiation of vasoactive agents for fluid-refractory shock, but acknowledge limited paediatric-specific evidence to guide agent selection or sequencing.

In their Review of the management of bronchiolitis, Stuart R Dalziel and colleagues 1 Dalziel SR Haskell L O'Brien S et al. Bronchiolitis. present data from a randomised trial in Canadian emergency departments that reported benefit from a combination of systemic corticosteroids and inhaled adrenaline, but no benefit from corticosteroids alone or adrenaline alone. However, after adjustment for multiple comparisons, the p value for the combination of corticosteroids and adrenaline was 0·07.

To determine whether the combination of systemic corticosteroids and nebulized epinephrine, compared with standard care, reduces the duration of positive pressure support in children with bronchiolitis admitted to intensive care. We performed a pragmatic, multicenter, open-label, randomized trial between July 2013 and November 2019 in children younger than 18 months old with a clinical diagnosis of bronchiolitis.