Nebulized Hypertonic Saline for Bronchiolitis

Wu, Susan; Baker, Chris; Lang, Michael E.; Schrager, Sheree M.; Liley, Fasha; Papa, Carmel; Mira, Valerie; Balkian, Ara; Mason, Wilbert H.

doi:10.1001/jamapediatrics.2014.301

Cited by 83 publications

(130 citation statements)

References 39 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…These findings are similar to those in recent studies conducted both with and without concomitant bronchodilators in the United States 15 and abroad, 17,19 but contradict findings of several other published studies. 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.…”

Section: Discussionsupporting

confidence: 86%

“…Based on expert judgment and similar to a previous US study, 15 we determined a clinically meaningful decrease in LOS (primary outcome) to be 0.6 days. We estimated prestudy infant bronchiolitis LOS (time of triage presentation to departure time from the hospital) at 2.85 days based on hospital administrative data.…”

Section: Sample Sizementioning

confidence: 99%

“…7,8 Some suggest nebulized 3% sodium chloride, hypertonic saline (HS), is helpful, 9-14 but results are contradictory. [15][16][17] Initial studies using HS for infants hospitalized with bronchiolitis suggest decreased LOS and improved severity scores. [9][10][11][12][13][14] Those studies differed from this study by excluding infants with previous wheeze, administering study medications with bronchodilators, or study subjects having much longer mean LOS.…”

Section: What This Study Addsmentioning

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%

“…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. The American Academy of Pediatrics (AAP) bronchiolitis guidelines updated in 2014 highlight the inconsistent findings regarding the effect of HS on LOS but suggest HS may be useful in infants admitted with bronchiolitis, particularly those with LOS .3 days.…”

Section: What This Study Addsmentioning

confidence: 99%

See 4 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: Discussionsupporting

confidence: 86%

Section: Sample Sizementioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

See 3 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

show abstract

Nebulized Hypertonic Saline for Bronchiolitis

2014

View full text Add to dashboard Cite

Association Between Hypertonic Saline and Hospital Length of Stay in Acute Viral Bronchiolitis

2016

View full text Add to dashboard Cite

IMPORTANCE Two previous meta-analyses of nebulized hypertonic saline (HS) on hospital length of stay (LOS) in acute viral bronchiolitis have suggested benefit. Neither study fully addressed the issue of excessive heterogeneity in the cohort of studies, indicating that it may be inappropriate to combine such dissimilar studies to estimate a common treatment effect. OBJECTIVE To reanalyze the existing data set for sources of heterogeneity to delineate the population most likely to benefit from HS. DATA SOURCES We used the previously analyzed cohort of randomized trials from 2 published meta-analyses comparing HS with normal saline (or, in 1 case, with standard of care) in infants hospitalized for bronchiolitis. We also repeated the search strategy used by the most recent Cochrane Review in the Medline database through September 2015. STUDY SELECTION Eighteen randomized clinical trials of HS in infants with bronchiolitis reporting LOS as an outcome measure were included. DATA EXTRACTION AND SYNTHESIS The guidelines used for abstracting data included LOS, study year, setting, sample size, type of control, admission/discharge criteria, adjunct medications, treatment frequency, mean day of illness at study enrollment, mean severity of illness scores, and mean age. MAIN OUTCOMES AND MEASURES Weighted mean difference in LOS and study heterogeneity as measured by the I 2 statistic. RESULTS There were 18 studies included of 2063 infants (63% male), with a mean age of 4.2 months. The mean LOS was 3.6 days. Two main sources of heterogeneity were identified. First, the effect of HS on LOS was entirely sensitive to the removal of one study population, noted to have a widely divergent definition of the primary outcome. Second, there was a baseline imbalance in mean day of illness at presentation between treatment groups. Controlling for either of these factors resolved the heterogeneity (I 2 = reduced from 78% to 45% and 0%, respectively) and produced summary estimates in support of the null hypothesis (that HS does not affect LOS). There was a weighted mean difference in LOS of −0.21 days (95% CI, −0.43 to +0.02) for the sensitivity analysis and +0.02 days (95% CI, −0.14 to +0.17) for studies without unbalanced treatment groups on presentation. CONCLUSIONS AND RELEVANCE Prior analyses were driven by an outlier population and unbalanced treatment groups in positive trials. Once heterogeneity was accounted for, the data did not support the use of HS to decrease LOS in infants hospitalized with bronchiolitis.

show abstract

Nebulized Hypertonic Saline for Bronchiolitis

Abstract: clinicaltrials.gov Identifier: NCT00619918.

Cited by 83 publications

References 39 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

Nebulized Hypertonic Saline for Bronchiolitis

Association Between Hypertonic Saline and Hospital Length of Stay in Acute Viral Bronchiolitis

Contact Info

Product

Resources

About