A randomized controlled study of nebulized 3% saline versus 0.9% saline with adrenaline in the treatment of acute bronchiolitis

Sreenivasa, B; Kumar, Pankaj; Babu, M T Suresh; K, Ragavendra

doi:10.32677/ijch.2015.v02.i02.004

Cited by 2 publications

(7 citation statements)

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“…(Percentage reduction in CSS in adrenaline with NS group on 1, 2 and 3 rd day was 3.4%, 2.1% & 4%. Percentage reduction in CSS in adrenaline with 3% NS group on 1, 2 and 3 rd day was 7.4%, 8.7% & 9.9% with p value <0.001) 11 In our study, the reduction in clinical severity score and length of hospital stay with adrenaline with 3% NS was significant in moderate bronchiolitis as compared to mild and severe bronchiolitis. (p value <0.001).…”

Section: Discussionsupporting

confidence: 46%

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

Chandrashekar¹,

Gopireddy²,

Tamatam³

et al. 2019

jebmh

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BACKGROUND Acute bronchiolitis is the most common lower respiratory tract infection in infants. It is characterized by fever, rhinitis, cough, tachypnoea, expiratory wheeze, crackles and increased respiratory effort. Approximately 20% of children develop bronchiolitis during their first year of life. 1 Supportive interventions including humidified oxygen and maintaining hydration remain the mainstay of management. Various other therapies including nebulised 3% saline, 0.9% saline, epinephrine and salbutamol, as well as inhaled and systemic corticosteroids have been studied with varying results. However, there are uncertainties over the optimal treatment strategy of bronchiolitis. METHODS Children were classified as having mild, moderate and severe disease based on clinical severity score by Wang et al. 2 Alternate children received nebulisation with 3% NaCl alone (3 ml) and adrenaline with 3% NaCl (0.5 ml + 2.5 ml). Nebulisations were given every 6 th hourly for the first 3 days and then tapered based on the symptoms. Clinical Severity Scores were recorded before & after first nebulization at the time of admission and then every morning (i.e., at 24 hrs, 48 hrs. and 72 hrs.). The duration of hospital stay was also studied. RESULTS A total of 277 children were included in the study (between Jan 2107 to June 2018), of which 64.8% of the patients were males and 35.1% were females. The mean age of the presentation was 9.9±6.2 months. The baseline CS (clinical severity) scores at admission in 0-3, 4-8 and 9+ score groups of 3% NS group were 3, 5.78±1.3 and 9.07±0.27 and of adrenaline with 3% NS group were 3, 5.57±1.3 and 9.36±0.49 respectively. After treatment the overall CS scores after 1st nebulisation with 3% NS and adrenaline with 3% NS at admission dropped to 5.21±1.65 and 4.16±1.89 respectively. The overall CS scores after 24 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 4.95±1.77 and 4.38±2.14 respectively. The overall CS scores after 48 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 3.67±1.86 and 2.60±2.08 respectively. The mean duration of hospital stay was 3.56±1.10 and 2.80±1.15 days in 3% NS and adrenaline with 3% NS respectively. CONCLUSIONS Adrenaline with 3% NS nebulisation is an effective and safe treatment for acute bronchiolitis. It significantly reduces the clinical severity scores and length of hospital stay as compared to 3% saline alone in acute bronchiolitis.

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Section: Discussionsupporting

confidence: 46%

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

Chandrashekar¹,

Gopireddy²,

Tamatam³

et al. 2019

jebmh

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“…Data from 14 trials were used to assess this outcome 20–22,24,26,28–30,32,36–40 . Of those, nine used CSS for bronchiolitis as a primary outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen trials [20][21][22][23]25,26,[28][29][30]32,36,38,40 were included in the metaanalysis to evaluate LOS, totalizing 1547 patients. Trials that included outpatients in LOS analysis 20,23,28,29,38 assessed this outcome as: (1) Time between admission and discharge in the emergency department or (2) time between admission in the emergency department and discharge after subsequent hospitalization.…”

Section: Length Of Stay In Hospital/edmentioning

confidence: 99%

“…[20][21][22]24,26,[28][29][30]32,[36][37][38][39][40] Of those, nine used CSS for bronchiolitis as a primary outcome. Three different scores were used on selected studies: Brochiolitis Severity Score (BSS) by Wang 41 (12 trials [20][21][22]24,[28][29][30]32,36,37,39,40 ), Respiratory Assessment Change Score/Respiratory Distress Assessment Instrument (RACS/RDAI) 42 (1 trial 38 ), and Wood-Downes Clinical Scoring System Modified by Ferres (WDF) 43 (1 trial 26 ). We used standard mean difference (SMD) to assess CSS, which is the preferred statistical method to represent continuous data if the studies measured the same outcome but used Six trials were used to analyze this outcome 22,24,29,[37][38][39] ; all of them used SaO 2 as a secondary outcome.…”

Section: Clinical Severity Scoresmentioning

confidence: 99%

“…31 SD numerical values were missing for CSS and could not be obtained from the authors in three studies. 22,28,32 To include these trials, the most conservative statistical method was chosen for imputation, as described in the Cochrane Handbook for Systematic Reviews of Interventions. 33 Special care was taken for reporting findings from outcome data collected at more than one point to avoid participant double-counting.…”

Section: Extraction and Management Of Datamentioning

confidence: 99%

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Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

Pereira¹,

Almeida²,

Zambrano³

et al. 2022

Health Science Reports

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Background: Nebulized epinephrine and hypertonic saline have been extensively studied in infants with acute bronchiolitis, with conflicting results.Aims: To evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO 2 ), and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis.Materials & Methods: This is a systematic review and meta-analysis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized.Results: Eighteen trials were systematically selected and 16 of them contributed to the meta-analysis (1756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of -0.35 days, 95% CI −0.62 to −0.08, p = 0.01, I 2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 and 72 h after the admission (SMD of −0.35, 95% CI −0.62 to −0.09, p = 0.008, I 2 = 41% and SMD of −0.27, 95% CI −0.50 to −0.04, p = 0.02, I 2 = 0%, respectively). No difference in SaO 2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient. Conclusion:Low-quality evidence from this systematic review suggests that nebulized epinephrine plus HS may be considered as a safe and efficient therapy for decreasing LOS and CSS in infants with acute bronchiolitis, especially in those who require hospitalization for more than 48 h.

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A randomized controlled study of nebulized 3% saline versus 0.9% saline with adrenaline in the treatment of acute bronchiolitis

Cited by 2 publications

References 13 publications

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

A COMPARATIVE STUDY ON NEBULISED ADRENALINE WITH 3% NaCl VERSUS 3% NaCl ALONE IN TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN AGED 2 MONTHS TO 2 YEARS

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

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