3% nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: This study evaluated the efficacy and safety of 3% nebulized hypertonic saline (NHS) in infants with acute bronchiolitis (AB).Methods: We systematically searched the PUBMED, EMBASE, Cochrane Library, China National Knowledge Infrastructure Database, WANFANG, and VIP databases from inception to June 1, 2022. We included randomized controlled trials comparing NHS with 0.9% saline. Outcomes included the length of hospital stay (LOS), rate of hospitalization (ROH), clinical severity score (CSS), rate of readmission, respiratory distress assessment instrument, and adverse events. RevMan V5.4 software was used for statistical analysis.Results: A total of 27 trials involving 3495 infants were included in this study. Compared to normal saline, infants received 3% NHS showed better outcomes in LOS reduction (MD = −0.60, 95% CI [−1.04, −0.17], I 2 = 92%, P = .007), ROH decrease (OR = 0.74, 95% CI [0.59, 0.91], I 2 = 0%, P = .005), CSS improvement at day 1 (MD = −0.79, 95% CI [−1.23, −0.34], I 2 = 74%, P < .001), day 2 (MD = −1.26, 95% CI [−2.02, −0.49], I 2 = 91%, P = .001), and day 3 and over (MD = −1.27, 95% CI [−1.92, −0.61], I 2 = 79%, P < .001), and respiratory distress assessment instrument enhancement (MD = −0.60, 95% CI [−0.95, −0.26], I 2 = 0%, P < .001). No significant adverse events related to 3% NHS were observed. Conclusion:This study showed that 3% NHS was better than 0.9% normal saline in reducing LOS, decreasing ROH, improving CSS, and in enhancing the severity of respiratory distress. Further studies are needed to validate these findings.Abbreviations: AB = acute bronchiolitis, AEs = adverse events, CI = confidence interval, CSS = clinical severity score, LOS = length of hospital stay, MD = mean difference, NHS = nebulized hypertonic saline, NS = normal saline, RCTs = randomized controlled trials, RDAI = respiratory distress assessment instrument, ROH = rate of hospitalization, ROR = rate of readmission, RR = risk ratio.

Expert group recommendation on inhaled mucoactive drugs in pediatric respiratory diseases: an Indian perspective

“…The mainstay of therapy for acute bronchiolitis includes airway support, gentle nasal suctioning, fluid administration, and adequate nutrition ( 58 , 59 ). Evidence ( Table 8 ) suggests that inhaled HS shortened the length of hospital stay and improved the clinical severity score (in the first 3 days) in children with acute bronchiolitis ( 58 , 63 – 65 ). Furthermore, treatment with inhaled HS may also substantially reduce the risk of hospitalization among outpatients and emergency department patients ( 58 ).…”

Untitled

“…conditions including rhinitis/rhinosinusitis or after endoscopic sinus surgery (ESS) [5][6][7][8][9]. This superiority is attributed to both osmotic decongestion and mechanical wash properties of hypertonic solutions as a result of the high ionic strength and the cleansing force of the irrigation solution, respectively.…”

The De-implementation of Bronchiolitis Medications

“…There is growing evidence that normal saline is not a true placebo and has its own therapeutic effect on bronchiolitis patients. [18][19][20][21][22][23][24] Consequently, studies that compare clinical improvement from albuterol with a normal saline placebo may be underestimating the therapeutic effect of albuterol. In that context, it was not clear why 2 studies with no designated placebo arm, but instead a comparative normal saline arm, were included without an acknowledgment in the Cochrane review.…”

“…There are also other perceived difficulties with the outpatient subanalyses. There is growing evidence that normal saline is not a true placebo and has its own therapeutic effect on bronchiolitis patients 18–24 . Consequently, studies that compare clinical improvement from albuterol with a normal saline placebo may be underestimating the therapeutic effect of albuterol.…”