Exploring the Efficacy of Using Hypertonic Saline for Nebulizing Treatment in Children with Bronchiolitis: a Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Acute bronchiolitis is the most common lower respiratory infection in children. It is particularly prone to dyspnea among children under two years old. Inhaled hypertonic saline (HS) has recently been shown to be a favorable therapy, because of its facility to draw fluid from the submucosa and adventitial spaces, decreasing airway edema. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of vapor treatment 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: In total, 4186 children from 32 publications were included. Compared to the control group, the HS group exhibited significantly reducing the level of severity of respiratory distress, included studies used the Clinical Severity Score (95% CI −1.15, −0.27, I² = 73%) and Respiratory Distress Assessment Instrument (95% CI −0.95, −0.26, I²= 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (95% CI −0.86, −0.32, I²= 81%). Conclusion: We conclude that nebulized 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 rigor randomize controlled trails with large sample size are needed.

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

“…The findings of the present study are partly consistent with those of previous studies. [54][55][56][57] In this study, the meta-analysis results showed significant differences between the 2 management strategies in terms of LOS reduction, ROH decrease, CSS improvement, and RDAI enhancement. This indicates that the efficacy of 3% NHS is better than that of 0.9% NS in the treatment of infants with AB.…”

“…However, their findings are inconsistent. [48,[54][55][56][57] In addition, 2 high-quality RCTs [29,41] were published after the most recent review. [54] Based on a previous study, this study updated the findings and provided the latest evidence for 3% NHS in infants with AB.…”

“…In addition, 5 previous similar systematic review addressed this issue. [53][54][55][56][57] However, they included pretty low quality trials, which may benefit their conclusions. Furthermore, 2 latest high quality trials [29,41] had published after the most recent review.…”

“…Furthermore, 2 latest high quality trials [29,41] had published after the most recent review. [54] Thus, it is very necessary to carry out an updated systematic review to explore this topic. Therefore, this study summarizes the latest evidence to systematically evaluate the efficacy and safety of 3% NHS for infants with AB.…”

Bronchodilator response to albuterol nebulized with hypertonic saline in asthmatic children

“…HSS has also been extensively evaluated in acute bronchiolitis 7 . Although some publications did not find relevant efficacy, 32 meta‐analysis studies in bronchiolitis showed that HSS has a positive influence on both hospitalization rates and the length of stay 33,34 . In these cases, the action is mainly attributed to a decrease of the respiratory epithelium edema and work of breathing.…”