Controlled Delivery of High vs Low Humidity vs Mist Therapy for Croup in Emergency Departments: A Randomized Controlled Trial

Division of Pediatric Emergency Medicine, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2006; 295(11):1274-80. DOI: 10.1001/jama.295.11.1274
Source: PubMed


Children with croup are often treated with humidity even though this is not scientifically based, consumes time, and can be harmful. Although humidity using the traditional blow-by technique is similar to room air and no water droplets reach the nasopharynx, particles sized for laryngeal deposition (5-10 microm) could be beneficial.
To determine whether a significant difference in the clinical Westley croup score exists in children with moderate to severe croup who were admitted to the emergency department and who received either 100% humidity or 40% humidity via nebulizer or blow-by humidity.
A randomized, single-blind, controlled trial conducted between 2001 and 2004 in a tertiary care pediatric emergency department.
A convenience sample of 140 previously healthy children 3 months to 10 years of age with Westley croup score of more than 1 or 2 or higher (scoring system range, 0-17); 21 families refused participation.
Thirty-minute administration of humidity using traditional blow-by technique (commonly used placebo, n = 48), controlled delivery of 40% humidity (optimally delivered placebo, n = 46), or 100% humidity (n = 46) with water particles of mass median diameter 6.21 microm.
A priori defined change in the Westley croup score from baseline to 30 and 60 minutes in the 3 groups.
Groups were comparable before treatment. At 30 minutes the difference in the improvement in the croup score between the blow-by and low-humidity groups was 0.03 (95% confidence interval [CI], -0.72 to 0.66), between low- and high-humidity groups, 0.16 (95% CI, -0.86 to 0.53), and between blow-by and high-humidity groups, 0.19 (95% CI, -0.87 to 0.49). Results were similar at 60 minutes. Differences between groups in pulse and respiratory rates and oxygen saturation changes were insignificant, as were proportions of excellent responders; proportions with croup score of 0 at study conclusion; and proportions receiving dexamethasone, epinephrine, or requiring additional medical care or hospitalization.
One hundred percent humidity with particles specifically sized to deposit in the larynx failed to result in greater improvement than 40% humidity or humidity by blow-by technique. This study does not support the use of humidity for moderate croup for patients treated in the emergency department. Identifier: NCT00230841.

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    • "Nevertheless, Neto and colleagues [26] described that mist therapy was not effective in improving clinical symptoms in children presenting to the emergency department with moderate croup. More recently, Scolnik and colleagues [27] found that even 100% humidity was not more effective when compared with mist therapy in the treatment of moderate croup. Because these treatments are harmless, many practitioners still use Fig. 1. "
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