Nebulised hypertonic saline solution for acute bronchiolitis in infants

Zhang, Linjie; Mendoza-Sassi, Raúl Andrés; Wainwright, Claire; Klassen, Terry P.

doi:10.1002/14651858.cd006458.pub3

Cited by 205 publications

(201 citation statements)

References 47 publications

(1 reference statement)

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…9,[11][12][13][14] Our results challenge the conclusions of the most recent Cochrane review of HS, 18 which suggests a potential benefit of HS. We believe this is partly attributed to the 2 to 3 times longer average LOS in the latter studies 9,[11][12][13][14] than in the studies in the United States and India.…”

Section: Discussioncontrasting

confidence: 62%

“…The Cochrane review of HS, 18 published while this study was enrolling, based recommendations on data from 1090 patients in 11 studies. Ours is the fifth negative study 15,17,19,20 since, totaling data from 1114 patients, demonstrating HS is not effective inpatient therapy for bronchiolitis.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,13,14 A 2013 Cochrane review of HS in bronchiolitis referencing the aforementioned studies suggested 3% HS given with bronchodilators may be considered a safe and effective treatment of infants with mild to moderate bronchiolitis. 18 Subsequent studies 15,17,19,20 suggest no benefit from HS for inpatients, despite concomitant use of bronchodilators in all but one, 19 which differed by being an open study. Results in Wu et al 15 may be limited to a subpopulation with a diminished response to HS, as the study began in the emergency department (ED), demonstrating decreased admission rate with HS.…”

Section: What This Study Addsmentioning

confidence: 99%

See 2 more Smart Citations

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

View full text Add to dashboard Cite

a abstract BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS:We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions.RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97).CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.WHAT'S KNOWN ON THIS SUBJECT: Bronchiolitis, the most frequent reason for hospitalization for infants younger than 1 year of age, has no proven treatments beyond supportive care. Although early studies suggested a potential benefit from 3% hypertonic saline, more recent studies have conflicting results. WHAT THIS STUDY ADDS:This prospective, randomized, double-blind, controlled trial in infants admitted with bronchiolitis (including patients with a history of previous wheeze) demonstrated no difference in length of stay between those who received hypertonic saline or normal saline without bronchodilators.

show abstract

Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

See 1 more Smart Citation

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

View full text Add to dashboard Cite

show abstract

“…And finally, they recommended 3% HS effective and safe treatment option (21). In our trial, median LOS was not different among three groups.…”

Section: Discussionmentioning

confidence: 51%

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

et al. 2016

View full text Add to dashboard Cite

Background:There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A -0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis. Keywords: Bronchiolitis, hypertonic saline, infant Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633:193-7 Comparing Bronchiolitis is the most frequent viral lower respiratory tract infection seen in infancy period characterized by cough, wheezing and tachypnea. Bronchiolitis is the major reason of infant hospitalization in both developed and developing countries. Although it is common there is no current standard treatment. Supportive care is the only evidence based treatment option (1,2). Many studies focused on testing the effects of bronchodilators such as β2-agonsits (3), epinephrine (4), glucocorticoids (5) and magnesium sulfate (6) with controversial results.There exists the first necrosis of the respiratory epithelium in bronchiolitis. Following by the fact that, exaggerated mucus production occurs due to the proliferation of goblet cells. On the other hand epithelial regeneration with nonciliated cells happens thus decreasing mucociliary clearance. Lymphocytic infiltration may result in submucosal edema (7). Johnson et al. (7) demonstrated that, airway obstruction in bronchiolitis was because of epithelial and inflammatory cell debris. And they did not observe bronchial smooth muscle constriction. This can explain why bronchodilator therapy is not effective in bronchiolitis. Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17). Thus,

show abstract

“…There is no evidence that inhaling normal 0.9% saline is useful in infant bronchiolitis (7). However, the Cochrane systematic review on hypertonic saline inhalations in bronchiolitis, which was updated in 2013, concluded that inhaling 3% hypertonic saline relieved the symptoms of bronchiolitis (11). The first version of the Finnish Current Care Guidelines for lower respiratory tract infection was published in electronic form in July 2014.…”

Section: What Are Evidence-based Guidelines and What Are They Not?mentioning

confidence: 99%

What are evidence‐based guidelines and what are they not?

Korppi

2015

Acta Paediatrica

View full text Add to dashboard Cite

Nebulised hypertonic saline solution for acute bronchiolitis in infants

Abstract: Current evidence suggests nebulised 3% saline may significantly reduce the length of hospital stay among infants hospitalised with non-severe acute viral bronchiolitis and improve the clinical severity score in both outpatient and inpatient populations.

Cited by 205 publications

References 47 publications

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

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

What are evidence‐based guidelines and what are they not?

Contact Info

Product

Resources

About