Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study

Gupta, Harish; Gupta, Vivek Vij Subash; Kaur, Gurmeet; Baidwan, Amitoz S; George, Pardeep P; Shah, Jay; Shinde, Kushal; Malik, Ruku; Chitkara, Neha; Bajaj, Krushnan V

doi:10.4103/2229-3485.179434

Cited by 14 publications

(12 citation statements)

References 10 publications

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“…Several studies [11, 12] concluded that hypertonic saline might promote the sputum induction, reduce the incidence of complications, while Huang et al [13, 14] found that hypotonic saline nebulization might be superior over isotonic saline in maintaining the airway patency and reducing pulmonary infection for patients with tracheostomy, interestingly, a recent study [15] found that hypertonic and isotonic saline nebulization offered no significant efficacy difference in patients with tracheostomy. So far, no studies have been performed to directly compare the efficacy of hypotonic, isotonic and hypertonic saline nebulization in clinic and lab settings.…”

Section: Introductionmentioning

confidence: 99%

The role of osmolality in saline fluid nebulization after tracheostomy: time for changing?

Wen

Cui

et al. 2016

BMC Pulm Med

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BackgroundSaline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear.ObjectivesTo investigate the biological changes in the early stage after tracheostomy, to verify the efficacy of saline fluid nebulization and explore the potential role of osmolality of saline nebulization after tracheostomy.MethodsSprague-Dawley rats undergone tracheostomy were taken for study model, the sputum viscosity was detected by rotational viscometer, the expressions of TNF-α, AQP4 in bronchoalveolar lavage fluid were assessed by western blot analysis, and the histological changes in endothelium were evaluated by HE staining and scanning electron microscopy (SEM).ResultsStudy results revealed that tracheostomy gave rise to the increase of sputum viscosity, TNF-α and AQP4 expression, mucosa and cilia damage, yet the saline fluid nebulization could significantly decrease the changes of those indicators, besides, the hypertonic, isotonic and hypertonic saline nebulization produced different efficacy.ConclusionsOsmolality plays an important role in the saline fluid nebulization after tracheostomy, and 3% saline fluid nebulization seems to be more beneficial, further studies on the role of osmolality in saline fluid nebulization are warranted.

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Section: Introductionmentioning

confidence: 99%

The role of osmolality in saline fluid nebulization after tracheostomy: time for changing?

Wen

Cui

et al. 2016

BMC Pulm Med

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“…The mean age of the patients in our study population was 9.9 ± 6.2 months (as compared to Gupta et al in which mean age at presentation was 5.7±3.4 months), the youngest being 2 months and the eldest being 24 months. 6 In our study, most of the children 115(46.5%) presented are in 7-12 months of age. The mean age observed by Sarrell et al is 12.5±6 months (range, 3-24 months), 7 Mandelberg et al is 2.9±2.1 months (range, 0.5-12 months), 8 Tal et al is 2.6±1 months (range, 1-5 months) and Kuzik et al is 4.7±4.2 months (range, 10 days to 18 months).…”

Section: Discussionmentioning

confidence: 49%

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

Chandrashekar¹,

Gopireddy²,

Tamatam³

et al. 2019

jebmh

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BACKGROUND Acute bronchiolitis is the most common lower respiratory tract infection in infants. It is characterized by fever, rhinitis, cough, tachypnoea, expiratory wheeze, crackles and increased respiratory effort. Approximately 20% of children develop bronchiolitis during their first year of life. 1 Supportive interventions including humidified oxygen and maintaining hydration remain the mainstay of management. Various other therapies including nebulised 3% saline, 0.9% saline, epinephrine and salbutamol, as well as inhaled and systemic corticosteroids have been studied with varying results. However, there are uncertainties over the optimal treatment strategy of bronchiolitis. METHODS Children were classified as having mild, moderate and severe disease based on clinical severity score by Wang et al. 2 Alternate children received nebulisation with 3% NaCl alone (3 ml) and adrenaline with 3% NaCl (0.5 ml + 2.5 ml). Nebulisations were given every 6 th hourly for the first 3 days and then tapered based on the symptoms. Clinical Severity Scores were recorded before & after first nebulization at the time of admission and then every morning (i.e., at 24 hrs, 48 hrs. and 72 hrs.). The duration of hospital stay was also studied. RESULTS A total of 277 children were included in the study (between Jan 2107 to June 2018), of which 64.8% of the patients were males and 35.1% were females. The mean age of the presentation was 9.9±6.2 months. The baseline CS (clinical severity) scores at admission in 0-3, 4-8 and 9+ score groups of 3% NS group were 3, 5.78±1.3 and 9.07±0.27 and of adrenaline with 3% NS group were 3, 5.57±1.3 and 9.36±0.49 respectively. After treatment the overall CS scores after 1st nebulisation with 3% NS and adrenaline with 3% NS at admission dropped to 5.21±1.65 and 4.16±1.89 respectively. The overall CS scores after 24 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 4.95±1.77 and 4.38±2.14 respectively. The overall CS scores after 48 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 3.67±1.86 and 2.60±2.08 respectively. The mean duration of hospital stay was 3.56±1.10 and 2.80±1.15 days in 3% NS and adrenaline with 3% NS respectively. CONCLUSIONS Adrenaline with 3% NS nebulisation is an effective and safe treatment for acute bronchiolitis. It significantly reduces the clinical severity scores and length of hospital stay as compared to 3% saline alone in acute bronchiolitis.

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“…In the previously reported clinical studies , the device was not specified in 11 cases, the MMAD in 12 cases, the aerosol output rate in 16 cases, and the gas vector in 16 cases. Because some studies [12,16,17,21,25] have used, like ours, nebulizations with air and have reported no side effects, the influence of the gas vector on the 3% HS tolerance is inconclusive. In our study, a higher proportion of adverse events were noted with the mesh nebulizer, maybe because of its high aerosol output rate that may favor cough and respiratory trouble.…”

Section: Discussionmentioning

confidence: 99%

“…In the previous studies looking, like ours, for a clinical effect, only few adverse events were reported, with nebulizations of 3% HS considered as safe and very well tolerated in in-patients with acute bronchiolitis [12][13][14][15][16][17][18][19][20][21][22][23][24][25] . Only 2 studies described a high rate of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…The pooled result of the main clinical studies on this subject is not convincing, either for out-patients [4][5][6][7][8][9][10][11] or for in-patients [12][13][14][15][16][17][18][19][20][21][22][23][24][25] . The most recent meta-analyses revealed a negative effect of the 3% HS [26,27], and the latest consensus statements [1,2] do not recommend its use.…”

Section: Introductionmentioning

confidence: 99%

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Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis

Carsin

Sauvaget

Bresson³

et al. 2017

Respiration

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Background: Albeit not recommended because of contradictory results, nebulized 3% hypertonic saline is widely used for treating acute viral bronchiolitis. Whether clinical differences may be attributed to the type of nebulizer used has never been studied. Objectives: By modifying the amount of salt deposited into the airways, the nebulizer characteristics might influence clinical response. Methods: A prospective, randomized, controlled trial included infants hospitalized in a French university hospital for a first episode of bronchiolitis. Each child received 6 nebulizations of 3% hypertonic saline during 48 h delivered with 1 of the 3 following nebulizers: 2 jet nebulizers delivering large or small particles, with a low aerosol output, and 1 mesh nebulizer delivering small particles, with a high aerosol output. The primary endpoint was the difference in the Wang score at 48 h. Results: Only 61 children of 168 were recruited before stopping this study because of severe adverse events (n = 4) or parental requests for discontinuation due to discomfort to their child during nebulization (n = 2). One minor adverse event was noted in 91.8% (n = 56/61) of children. A high aerosol output induced 75% of the severe adverse events; it was significantly associated with the nebulization-induced cough between 24 and 48 h (p = 0.036). Decreases in Wang scores were not significantly different between the groups at 48 h, 9 recoveries out of 10 being obtained with small particles. Conclusion: No beneficial effects and possibly severe adverse events are observed with 3% hypertonic saline in the treatment of bronchiolitis.

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Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study

Cited by 14 publications

References 10 publications

The role of osmolality in saline fluid nebulization after tracheostomy: time for changing?

The role of osmolality in saline fluid nebulization after tracheostomy: time for changing?

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis

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