Rebound stridor in children with croup after nebulised adrenaline: does it really exist?

Sakthivel, Muthukumar; Elkashif, Sami; Al Ansari, Khalid; Powell, Colin V.E.

Kristjansson et al. [14] reported re-emergence of symptoms in 35% of children receiving nebulised adrenaline and in 25% of children receiving placebo. No steroids were used. They posited that it is not likely that the phenomenon is related to adrenaline only, but rather to ongoing inflammation and oedema in the airway. They concluded that nebulised adrenaline is effective for the treatment of acute mild to moderately severe croup and that it should be used as a first line treatment [14] . This has not been taken up universally, but it is now standard practice in some countries to use steroids and nebulised adrenaline in the emergency department, watch the patients for 2 h and then discharge home if well enough [2] . The final two studies both used steroids and nebulised adrenaline, showing clearly a good response to the treatment with no rebound or indeed any major re-emergence of symptoms [12, 13] .