Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis

Luo, Zhengxiu; Fu, Zhou; Liu, E.; Xu, Xiaomin; Fu, Xue‐Qin; Peng, Donghong; Liu, Yongcan; Li, S.; Zeng, Feng-Qiong; Yang, Xin

doi:10.1111/j.1469-0691.2010.03304.x

Cited by 59 publications

(145 citation statements)

References 18 publications

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“…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. It is possible that HS has a greater effect when administered over a longer period of time than in an acute setting with a shorter LOS.…”

Section: Discussioncontrasting

confidence: 57%

“…[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. 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.…”

Section: What This Study Addsmentioning

confidence: 97%

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

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

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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.

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Section: Discussioncontrasting

confidence: 57%

Section: What This Study Addsmentioning

confidence: 97%

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

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

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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%

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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“…In a follow-up study, Luo et al 35 conducted a prospective, randomized, controlled trial to determine the efficacy and safety of 4 mL of inhaled nebulized hypertonic saline vs 4 mL of inhaled nebulized NS in hospitalized infants with moderate to severe bronchiolitis. The authors compared signs and symptoms, CSS, and LOS of infants in the hypertonic saline group with those of the NS group.…”

Section: Clinical Trials Evaluating Hypertonic Saline Use In Hospitalsmentioning

confidence: 99%

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.INDEX TERMS: bronchiolitis, hypertonic saline, infants, pediatrics, review J Pediatr Pharmacol Ther 2016;21(1):7-26

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Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis

Cited by 59 publications

References 18 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

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

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

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