Eficacia de la epinefrina racémica en comparación con la presión positiva continua en la vía aérea (CPAP) en el tratamiento de niños con bronquiolitis aguda: revisión sistemática

Abstract

Title: Efficacy of Racemic Epinephrine Compared to Continuous Positive Airway Pressure (CPAP) in the Treatment of Children with Acute Bronchiolitis: A Systematic Review. Objective: To determine the efficacy of racemic epinephrine compared to continuous positive airway pressure (CPAP) in treating children with acute bronchiolitis, with the aim of identifying which procedure provides greater clinical benefits.

Methodology: The study followed PRISMA 2020 guidelines. It included clinical trials in Spanish and English published between 2010 and 2025, excluding incomplete studies, systematic reviews, among others. Searches were conducted in databases such as PubMed, Scopus, and ProQuest. The risk of bias was assessed using the Cochrane RoB-2 tool, and the data were presented in tables.

Results: Thirteen clinical trials involving over 1,000 pediatric patients were analyzed. CPAP showed effective management in moderate to severe cases within the intensive care units (ICU), improving respiratory parameters. Epinephrine demonstrated great utility in mild cases or as a supplement to reduce hospitalizations.

Discussion: CPAP demonstrates greater efficacy in severe cases; however, its use may be limited by available resources or infrastructure. In contrast, epinephrine is an accessible and safe alternative in less complex contexts. Limitations identified include methodological heterogeneity and variability in the evaluated outcomes.

Conclusion: CPAP is the most effective option for moderate to severe bronchiolitis. Epinephrine is useful and safe for mild cases where non-invasive ventilatory support is unavailable.