7% Hypertonic Saline in Acute Bronchiolitis: A Randomized Controlled Trial

Abstract

BACKGROUND: Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated. METHODS: We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay. RESULTS: At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant. CONCLUSIONS: In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

“…1 In conclusion, we agree with the AAP guidelines 1 regarding the use of nebulized hypertonic saline to reduce bronchiolitis scores and LOS for infants with bronchiolitis who are expected to be hospitalized for more than 72 hours. We also note that recent trials [21][22][23][24][25][26][27][28][29][30][31] suggest that hypertonic saline reduces admission rates from the ED, and we believe there may be a role for hypertonic saline in this setting. Given the safety of this therapy and the lack of other effective therapies for these patients, use of hypertonic saline should be attempted in multiple doses in all patient care settings where nebulization can be administered.…”

“…26,28,30,31 The determination by the AAP that hypertonic saline is not effective in this setting is intriguing in light of the effectiveness of both forms of saline (NS and hypertonic saline) in these trials.…”

“…Additionally, differences in baseline characteristics between groups, use of a single dose of hypertonic saline, short assessment times (1 hour for most patients), and the use of an active control may have affected the outcomes of this study. Jacobs et al 30 were the first to evaluate the efficacy and safety of 7% hypertonic saline with racemic epinephrine vs 7% NS with racemic epinephrine in patients with acute bronchiolitis in the ED. Their primary hypothesis was that the use of hypertonic saline would improve the severity of bronchiolitis.…”

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

“…Our results were opposed with Nenna's findings. On the other hand, Jacobs et al (18) treated 101 bronchiolitis with 7% HS plus epinephrine or 0.9% saline plus epinephrine in the emergency department and they concluded that 7% HS did not show any clinically significant decrease in CSS. The fact that they did not calculate the LOS limited study.…”

“…In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15)(16)(17). Thus, recently 7% HS has been studied in infants with bronchiolitis (18,19). But the effect of 7 % HS treatment to the bronchiolitis outcome is still dilemma.…”