Nebulized hypertonic saline solution for acute bronchiolitis in infants

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

doi:10.1002/14651858.cd006458.pub2

Cited by 160 publications

(165 citation statements)

References 37 publications

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“…The effect was already significant after the first 24 hours of therapy and was sustained through the third day of treatment, allowing to discharge the infants treated with 3% HS one day earlier than the NS treated group. Our data confirm previous evidence (8-10, 14) revised in recent reviews on the effectiveness of nebulized HS as treatment for bronchiolitis in infants (15,16). Four trials involving 254 infants were considered (8)(9)(10)14), showing that nebulized 3% HS effectively determined a shorter mean length of (15,16).…”

Section: Discussionsupporting

confidence: 88%

“…Our data confirm previous evidence (8-10, 14) revised in recent reviews on the effectiveness of nebulized HS as treatment for bronchiolitis in infants (15,16). Four trials involving 254 infants were considered (8)(9)(10)14), showing that nebulized 3% HS effectively determined a shorter mean length of (15,16). The findings on the clinical scores were more relevant among outpatients than inpatients, probably due to the reduced severity of the disease.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

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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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

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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“…6 A 2008 Cochrane database systematic review stated that nebulized 3% saline may significantly reduce the length of hospital stay and improve the clinical severity score in infants with acute viral bronchiolitis. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…17,19 Nevertheless, these descriptions also overlap and are based on past studies influenced by the same sampling error mentioned earlier. In addition, is it more reasonable to point to these differences as evidence of two distinct illnesses with very different treatment guidelines (as we Hypertonic saline 8 11 Yes (inpatients only) 3 (27) 11 (100) 1 (9) 3 (27) 7 (64) have done in the past) or to accept that perhaps bronchiolitis is simply what viral-triggered asthma looks like in infants? After all, we know that the lungs of infants are more prone to small airway occlusion and atelectasis during upper or lower respiratory tract infections compared with older children.…”

Section: Isn't This Just Asthma?mentioning

confidence: 99%

“…In a reappraisal of an earlier Cochrane Review of this topic, it was noted that inhalation with normal saline alone successfully reduced respiratory distress scores in 43% of infants in the control arms. 20 We already know that inhaled 3% hypertonic saline improves airway clearance in bronchiolitis 8 and that perhaps it is the total amount of sodium chloride delivered to the airway surface, and not the concentration nebulized, that is beneficial. 21,22 It is therefore not surprising that inhalation of normal saline appears to be beneficial in bronchiolitis.…”

Section: But If It's Asthma Then Why Don't Asthma Medications Work?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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Nebulized hypertonic saline solution for acute bronchiolitis in infants

Cited by 160 publications

References 37 publications

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

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

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

Maybe there is no such thing as bronchiolitis

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