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Nebulized Hypertonic Saline for Bronchiolitis
Am Fam Physician. 2018 Jul 1;98(1):23-24.
Details for This Review
Study Population: Children younger than 24 months with bronchiolitis (3,209 participants in 24 trials). Most trials excluded patients who required mechanical ventilation, intensive care, or those who had oxygen saturation less than 85% on room air.
Efficacy End Points: Length of hospital stay, rate of hospitalization
Harm End Points: Tachycardia, hypertension, pallor, tremor, nausea, vomiting, diarrhea, and acute urinary retention
Narrative: Bronchiolitis is the most common lower respiratory tract infection in infants, with respiratory syncytial virus being the leading cause. Airway edema and mucus plugging are believed to be the pathologic processes causing morbidity in cases of viral bronchiolitis. Supportive treatment is the standard of care. In addition, nebulized hypertonic saline may be beneficial in relieving symptoms.
A systematic review included double-blind, randomized, controlled clinical trials evaluating the effect of nebulized hypertonic (3% or higher) saline solution alone or in conjunction with bronchodilators in infants with acute bronchiolitis compared with nebulized normal (0.9%) saline.1 Nebulized hypertonic saline resulted in a statistically significant reduction in length of hospital stay (mean difference: −0.45 day; 95% confidence interval [CI], −0.82 to −0.08). Nebulized hypertonic saline also reduced the risk of hospitalization by 20% compared with 0.9% saline (relative risk [RR] = 0.80; 95% CI, 0.67 to 0.96). No significant adverse events related to hypertonic saline inhalation were reported.
The lead author of this systematic review published a Cochrane review on the same topic in 2013.2 That meta-analysis showed a mean reduction of 1.2 days (95% CI, 0.8 to 1.5 days) in the length of hospital stay and no significant difference in the rate of hospitalization.2 We chose to write our summary based on the 2015 meta-analysis because it is more recent and includes several recent trials and approximately 2,000 more patients than the 2013 Cochrane review.
A 2014 meta-analysis reported an approximately one-day decrease in the length of hospital stay (weighted mean difference
Referencesshow all references
1. Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized hypertonic saline for acute bronchiolitis: a systematic review [published correction appears in Pediatrics. 2016;137(4):pii:e20160017]. Pediatrics. 2015;136(4):687–701....
2. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2013;(7):CD006458.
3. Chen YJ, Lee WL, Wang CM, Chou HH. Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis. Pediatr Neonatol. 2014;55(6):431–438.
4. Angoulvant F, Bellêttre X, Milcent K, et al.; Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) Study Group. Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2017;171(8):e171333.
5. Sharma BS, Gupta MK, Rafik SP. Hypertonic (3%) saline vs 0.93% saline nebulization for acute viral bronchiolitis: a randomized controlled trial. Indian Pediatr. 2013;50(8):743–747.
6. Florin TA, Shaw KN, Kittick M, Yakscoe S, Zorc JJ. Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial. JAMA Pediatr. 2014;168(7):664–670.
7. Teunissen J, Hochs AH, Vaessen-Verberne A, et al. The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial. Eur Respir J. 2014;44(4):913–921.
8. Everard ML, Hind D, Ugonna K, et al.; SABRE Study Team. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis. Thorax. 2014;69(12):1105–1112.
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