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Nebulized hypertonic saline solution for acute bronchiolitis in infants

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Abstract

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Background

Airway edema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulized hypertonic saline solution may reduce these pathological changes and decrease airway obstruction.

Objectives

To assess the effects of nebulized hypertonic saline solution in infants with acute viral bronchiolitis.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), which contains the Cochrane Acute Respiratory Infections Group Specialized Register, OLDMEDLINE (1951 to 1965), MEDLINE (1966 to May Week 4, 2010), EMBASE (1974 to June 2010) and LILACS (1985 to June 2010).

Selection criteria

Randomized controlled trials (RCTs) and quasi‐RCTs using nebulized hypertonic saline alone or in conjunction with bronchodilators as an active intervention in infants up to 24 months of age with acute bronchiolitis.

Data collection and analysis

Two review authors independently performed data extraction and study quality assessment. We performed meta‐analyses using the Cochrane statistical package RevMan 5. We used the random‐effects model for meta‐analyses. We used mean difference (MD) and risk ratio (RR) as effect size metrics.

Main results

We included seven trials (581 infants) with mild to moderate acute viral bronchiolitis (282 inpatients, 65 outpatients and 234 emergency department patients). Patients treated with nebulized 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulized 0.9% saline (MD ‐1.16 days, 95% CI ‐1.55 to ‐0.77, P < 0.00001). The 3% saline group also had a significantly lower post‐inhalation clinical score than the 0.9% saline group in the first three days of treatment (day 1: MD ‐0.95, 95% CI ‐1.52 to ‐0.39, P = 0.0009; day 2: MD ‐1.31, 95% CI ‐1.87 to ‐0.75, P < 0.00001; day 3: MD ‐1.31, 95% CI ‐2.01 to ‐0.61, P = 0.0003). The effects of improving clinical score were observed in both outpatients and inpatients. Two emergency department‐based trials failed to show significant short‐term effects (30 to 120 minutes) of up to two doses of nebulized hypertonic saline in improving clinical score and oxygen saturation. No significant adverse events related to 3% saline inhalation were reported.

Authors' conclusions

Current evidence suggests nebulized 3% saline may significantly reduce the length of hospital stay among infants hospitalized with non‐severe acute viral bronchiolitis and improve the clinical severity score in both outpatient and inpatient populations.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Nebulized hypertonic saline solution for acute bronchiolitis in infants

Acute viral bronchiolitis is the most common lower respiratory tract infection in infants, but the standard treatment remains supportive care. This review was conducted to assess the effects of 3% saline solution administered via nebulizer, which can increase clearance of mucus, in these patients. We included seven randomized trials involving 581 infants with mild to moderate bronchiolitis. Meta‐analysis suggests that nebulized 3% saline may significantly reduce the length of hospital stay among infants hospitalized for non‐severe acute bronchiolitis and improve the clinical severity score in both outpatient and inpatient populations. No significant short‐term effects (30 to 120 minutes) of one to two doses of nebulized hypertonic saline were observed among emergency department patients; however, more trials are needed to address this question. There were no significant adverse effects noted with nebulized hypertonic saline when administered along with bronchodilators.