Abstract:-146.1] h) (P ؍ .03 by Wilcoxon rank-sum test). After adjusting for baseline levels of PEEP, the duration of mechanical ventilation did not differ between groups.Mechanical ventilation parameters, including dead space and dynamic compliance, did not differ between measurements taken before study drug administration versus measurements taken after. New onset wheezing following study drug administration was rare (1.0% with hypertonic saline vs 3.0% with placebo, P ؍ .36 by chi-square test). CONCLUSIONS: Admi… Show more
“…Although a small group of subjects may not allow generalization of findings, the possibility that those subjects could have been adversely affected by disconnection while receiving hypertonic saline cannot be ruled out. Despite some obvious limitations of the study by Shein et al 15 , their results are consistent with a few trials where nebulized hypertonic saline did not significantly improve any of the clinical outcomes measured. 14,18,19 The evidence supporting the prophylactic use of nebulized hypertonic saline for patients undergoing mechanical ventilation as a mucoactive agent and its impact on clinical outcomes is lacking.…”
Section: See the Original Study On Page 586supporting
confidence: 79%
“…14,15,18 Nevertheless, the most recent meta-analysis evaluating the therapeutic and prophylactic nebulization of mucoactive agents in adult critically ill patients found very low quantity and quality of evidence to support their use. 14 Little evidence exists of their prophylactic use in the pediatric critical care setting to decrease the duration of mechanically ventilation, and no prospective blinded studies in children undergoing mechanical ventilation have been reported.…”
Section: See the Original Study On Page 586mentioning
confidence: 99%
“…14 Little evidence exists of their prophylactic use in the pediatric critical care setting to decrease the duration of mechanically ventilation, and no prospective blinded studies in children undergoing mechanical ventilation have been reported. In this issue of RESPIRATORY CARE, Shein et al 15 conducted a blind randomized pilot study on the use of hypertonic saline in mechanically ventilated subjects. They investigated the use of nebulized hypertonic saline to improve airway clearance and shorten the duration of mechanical ventilation.…”
Section: See the Original Study On Page 586mentioning
“…Although a small group of subjects may not allow generalization of findings, the possibility that those subjects could have been adversely affected by disconnection while receiving hypertonic saline cannot be ruled out. Despite some obvious limitations of the study by Shein et al 15 , their results are consistent with a few trials where nebulized hypertonic saline did not significantly improve any of the clinical outcomes measured. 14,18,19 The evidence supporting the prophylactic use of nebulized hypertonic saline for patients undergoing mechanical ventilation as a mucoactive agent and its impact on clinical outcomes is lacking.…”
Section: See the Original Study On Page 586supporting
confidence: 79%
“…14,15,18 Nevertheless, the most recent meta-analysis evaluating the therapeutic and prophylactic nebulization of mucoactive agents in adult critically ill patients found very low quantity and quality of evidence to support their use. 14 Little evidence exists of their prophylactic use in the pediatric critical care setting to decrease the duration of mechanically ventilation, and no prospective blinded studies in children undergoing mechanical ventilation have been reported.…”
Section: See the Original Study On Page 586mentioning
confidence: 99%
“…14 Little evidence exists of their prophylactic use in the pediatric critical care setting to decrease the duration of mechanically ventilation, and no prospective blinded studies in children undergoing mechanical ventilation have been reported. In this issue of RESPIRATORY CARE, Shein et al 15 conducted a blind randomized pilot study on the use of hypertonic saline in mechanically ventilated subjects. They investigated the use of nebulized hypertonic saline to improve airway clearance and shorten the duration of mechanical ventilation.…”
Section: See the Original Study On Page 586mentioning
“…A recent prospective study in intubated and mechanically ventilated children demonstrated no reduction in the duration of mechanical ventilation in a group who received 3% inhaled hypertonic saline compared with those who received normal saline aerosols. 99 Additionally, there was no improvement in lung mechanics or chest radiographic appearance following hypertonic saline administration, but 2 subjects had to be removed from the study because of hypoxemia that developed after hypertonic saline administration. Radioisotope studies of mucociliary clearance in healthy subjects treated with 3% inhaled hypertonic saline showed an initial acceleration of mucociliary clearance over the first 30 min after hypertonic saline inhalation but a slowing in mucociliary clearance at 3-6 h. 100 The authors speculated that the reduction in clearance was the result of depletion of mucus in the central airways.…”
Section: Medications That Alter Mucociliary or Cough Clearancementioning
Children with progressive neuromuscular weakness undergo a stereotypical progression of respiratory involvement, beginning with impaired airway clearance and progressing to nocturnal and then diurnal ventilatory failure. This review examines issues related to airway clearance and mucus mobilization, sleep problems, and use of assisted ventilation in children with neuromuscular diseases. Interventions for each of these problems have been created or adapted for the pediatric population. The use of airway clearance therapies and assisted ventilation have improved survival of children with neuromuscular weakness. Questions regarding the best time to introduce some therapies, the therapeutic utility of certain interventions, and the cost-effectiveness of various treatments demand further investigation. Studies that assess the potential to improve quality of life and reduce hospitalizations and frequency of lower-respiratory tract infections will help clinicians to decide which techniques are best suited for use in children. As children with neuromuscular disease survive longer, coordinated programs for transitioning these patients to adult care must be developed to enhance their quality of life.
“…However, in this non-blinded trial, no statistically significant differences in duration of mechanical ventilation, oxygen therapy or PICU stay between the groups were found. Similarly, Shein et al have focused on expectorants by studying routine nebulization with hypertonic (3%) saline versus normal (0.9%) saline in a pilot study [103]. With a very small sample size (n = 18), they found no differences between the groups for a number of outcomes, including duration of mechanical ventilation or chest Xray atelectasis score, as well as respiratory mechanics parameters before and after intervention.…”
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