Nebulized lidocaine in the treatment of severe acute bronchiolitis in children: A cohort study with retrospective and prospective arms

Abstract

Severe acute bronchiolitis is a common cause of hospitalization in infants and young children. Standard treatments like oxygen therapy and hydration provide limited relief. Nebulized lidocaine, an anesthetic with anti-inflammatory and bronchodilatory properties, has shown promise in respiratory conditions involving airway inflammation. It works by inhibiting neurogenic inflammation, reducing bronchoconstriction, and modulating airway reflexes, potentially alleviating respiratory distress in bronchiolitis. Previous studies have shown lidocaine’s benefits in conditions like asthma and COPD, where airway hyperresponsiveness is common. Its potential to improve pulmonary function and reduce the need for invasive interventions suggests that nebulized lidocaine may be an effective adjunct therapy for severe bronchiolitis. This cohort study aims to evaluate the effectiveness and safety of nebulized lidocaine in improving respiratory parameters and reducing hospital stay in children with severe acute bronchiolitis. This study includes both retrospective and prospective arms, involving children aged 1 month to 2 years diagnosed with severe acute bronchiolitis. The retrospective arm reviews medical records of children treated before the introduction of nebulized lidocaine at Saint George Hospital University Medical Center (SGHUMC), while the prospective arm evaluates children treated after nebulized lidocaine was introduced. Key outcomes studied include respiratory rate, oxygen saturation, clinical severity scores, and hospital length of stay (LOS). The findings are that clinical outcomes, including oxygen saturation, requirements for mechanical ventilation and length of hospital stay, were more favorable in the prospective cohort, following the introduction of nebulized lidocaine, compared to the retrospective cohort. Results suggest that the introduction of nebulized lidocaine may be associated with more favorable clinical outcomes in severe bronchiolitis cases.