Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials

Abstract

Background Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of treatment with nebulized HS among children with bronchiolitis. Methods A systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis. Results There were 4186 children from 32 publications included. Compared to the control group, the HS group exhibited significant reduction of severity of respiratory distress, included studies used the Clinical Severity Score (n = 8; MD, − 0.71; 95% CI, − 1.15 to − 0.27; I2 = 73%) and full stop after Respiratory Distress Assessment Instrument (n = 5; MD, − 0.60; 95% CI, − 0.95 to − 0.26; I2 = 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (n = 20; MD, − 0.54; 95% CI, − 0.86 to − 0.23; I2 = 81%). Conclusions We conclude that nebulization with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigorous randomized controlled trials with large sample size are needed.

UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants

“…However, controversial data supports the use of the hypertonic saline solution in infants with bronchiolitis. While several RCTs enrolling patients with moderateto-severe bronchiolitis showed that the administration of nebulized hypertonic saline solution, alone or in addition to other therapies, did not provide any clinical benefit and rather caused more frequently mild adverse events [74][75][76][77][78][79], other RCTs and systematic reviews reported that nebulized 3% hypertonic solution appeared safe and more effective in improving clinical severity compared to 0.9% saline solution [80][81][82][83][84][85].…”

Hiệu Của Của Khí Dung Natriclorid 3% Trong Điều Trị Viêm Tiểu Phế Quản Cấp Ở Trẻ Dưới 2 Tuổi Tại Bệnh Viện Bạch Mai

“…Thể tích nước muối được lựa chọn là 4 ml là phù hợp với nhiều nghiên cứu khác trên thế giới. Tác giả Chia-Wen Hsieh [3] thực hiện nghiên cứu tổng hợp trên 4168 trẻ trong 32 nghiên cứu RCT cho thấy thể tích nước muối được lựa chọn là từ 2,5ml tới 5m. Trong đó, mứ thể tích 4m chiếm đa số với tỷ lệ gặp 19 trên 32 nghiên cứu.…”

Comparison of hypertonic-saline vs normal-saline nebulization in children with bronchiolitis.

“…1,3,6 Backbone of treatment is still supportive care with adequate hydration and oxygen inhalation to maintain normal saturation, with no defined role of antibiotics, steroids, and bronchodilator while few studies are favouring use of hypertonic saline in bronchiolitis by decline in duration of hospital stay and oxygen inhalation, whereas some other studies are reporting equivocal response with hypertonic saline and conventional therapy. [7][8][9][10][11] This study was conducted to assess the impact of nebulization with hypertonic saline (HS) i.e. 4 As per sample size, sixty pediatric patients accomplishing the inclusion and exclusion criteria were included in the study and were randomly divided into two groups by lottery method.…”