Nebulized 5% or 3% Hypertonic or 0.9% Saline for Treating Acute Bronchiolitis in Infants

Alansari, Khalid; Sakran, Mahmoud; Davidson, Bruce L.; Sayyed, Rafah El; Mahjoub, Hella; Ibrahim, Khalid

doi:10.1016/j.jpeds.2010.04.074

Cited by 77 publications

(116 citation statements)

References 15 publications

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“…7 Since this review, additional studies have evaluated HS in infants with bronchiolitis: 1 in an ambulatory setting, 3 in an emergency department (ED), and 5 in hospitalized patients. 6,[8][9][10][11][12][13][14][15][16] All of these studies have shown a reduction in pulmonary severity scores and/or a trend toward reduced admission rates in the HS group. Of note, all investigations to date have shown HS to be safe, with no patients experiencing decreased oxygen saturation, apnea, or cyanosis after administration of the medication.…”

Section: Discussionmentioning

confidence: 99%

“…Further, most of the previous studies in bronchiolitis have used similar models, by using HS combined with a bronchodilator to demonstrate a clinical improvement. [8][9][10]15,16,21 However, HS appears to be safe when used alone to treat infants with bronchiolitis. 11,12,22 Another limitation is that the modified BSS is not widely used and has not been externally validated.…”

Section: Articlementioning

confidence: 99%

“…11,12,22 Another limitation is that the modified BSS is not widely used and has not been externally validated. 8 However, it has been an established respiratory assessment tool in our institution for more than 7 years and incorporates all the major criteria used by other scoring systems for bronchiolitis, including oxygen saturation. Further, it demonstrated good interobserver agreement and was highly correlated with the BSS previously published.…”

Section: Articlementioning

confidence: 99%

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

Jacobs

Foster²,

Wan

et al. 2014

Pediatrics

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Articlementioning

confidence: 99%

Section: Articlementioning

confidence: 99%

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

Jacobs

Foster²,

Wan

et al. 2014

Pediatrics

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“…The optimal concentration of HS to be used for treating acute bronchiolitis has been recently debated: Al-Ansari et al showed that, in addition to epinephrine, nebulized 5% HS was safe and probably superior in efficacy not only to NS but also to 3% HS (11). However, this study was carried out in a pre-hospital setting and on children with mild bronchiolitis as demonstrated by the lower CSS and the higher 02 saturation values at baseline in comparison to the parameters of infants enrolled in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The use ofnebulized hypertonic saline solution (HS) was demonstrated to be effective to decrease symptoms (8,9) and length of hospitalization in association to~-adrenergic drugs (9,10). In a pre-hospital setting, Al-Ansari et al compared the effects of 5% vs 3% HS in addition to epinephrine, showing a better response to the more concentrated solution in term of clinical severity scores (11). More recently, it has been shown that in the treatment of acute bronchiolitis in an emergency department setting, the use of nebulized 3% HS added to epinephrine did not improve clinical outcomes more than normal saline (NS) and epinephrine (12).…”

mentioning

confidence: 99%

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Giudice

Saitta²,

Leonardi

et al. 2012

Int J Immunopathol Pharmacol

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The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days, reaching a significant decrease in stay (p<0.05). In hospitalized patients bronchiolitis nebulized 3% HS and epinephrine significantly decreased symptoms and LOS as compared to 0.9% NS and epinephrine.

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