From the Research
The frequency of racemic epinephrine breath treatments should generally be limited to no more than every 2 hours as needed, with most protocols recommending a maximum of 3-4 treatments in a 24-hour period. This recommendation is based on the need to balance the benefits of racemic epinephrine in reducing airway edema and improving breathing in conditions like croup or post-extubation stridor, with the potential risks of repeated administration, such as tachycardia, hypertension, and rebound bronchospasm 1. Some key points to consider when administering racemic epinephrine breath treatments include:
- Each treatment typically consists of 0.5 mL of 2.25% racemic epinephrine solution diluted in 3 mL of normal saline, delivered via nebulizer.
- Patients receiving multiple treatments should be closely monitored for potential side effects of repeated administration.
- Extended or frequent use may lead to decreased effectiveness due to tachyphylaxis.
- If a patient requires more than 3-4 treatments in 24 hours, this suggests inadequate response to therapy and alternative treatments should be considered. It's also important to note that racemic epinephrine works by stimulating both alpha and beta-adrenergic receptors, causing vasoconstriction and bronchodilation, which reduces airway edema and improves breathing in conditions like croup or post-extubation stridor 2. The treatment should be used cautiously in patients with cardiovascular disease, hypertension, hyperthyroidism, or diabetes.