A Randomized Trial of Nebulized 3% Hypertonic Saline With Epinephrine in the Treatment of Acute Bronchiolitis in the Emergency Department

Grewal, Simran; Ali, Samina; McConnell, Don W.; Vandermeer, Ben; Klassen, Terry P.

doi:10.1001/archpediatrics.2009.196

Cited by 88 publications

(99 citation statements)

References 26 publications

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“…This could be an explanation for recent controversial results showing that nebulized 3% HS with epinephrine in the treatment of acute bronchiolitis in an Emergency Department did not improve clinical outcome any more than NS (12). In fact, in this study the enrolled infants were evaluated only for 120 minutes after the nebulisation, without any difference in respiratory distress scores, change in oxygen saturation, rate of hospital admissions and return to the ED (12). As the authors admit, patients received only a maximum of 2 drug doses and respiratory parameters were measured for no longer than 120 minutes (12).…”

Section: Discussionmentioning

confidence: 90%

“…In a pre-hospital setting, Al-Ansari et al compared the effects of 5% vs 3% HS in addition to epinephrine, showing a better response to the more concentrated solution in term of clinical severity scores (11). More recently, it has been shown that in the treatment of acute bronchiolitis in an emergency department setting, the use of nebulized 3% HS added to epinephrine did not improve clinical outcomes more than normal saline (NS) and epinephrine (12). However, therapies that may contribute to the reduction in hospital stay could potentially greatly reduce health costs related to bronchiolitis (2).…”

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confidence: 99%

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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: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

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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“…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%

“…Further, most of the previous studies in bronchiolitis have used similar models, by using HS combined with a bronchodilator to demonstrate a clinical improvement. [8][9][10]15,16,21 However, HS appears to be safe when used alone to treat infants with bronchiolitis. 11,12,22 Another limitation is that the modified BSS is not widely used and has not been externally validated.…”

Section: Articlementioning

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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“…Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17).…”

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confidence: 99%

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

et al. 2016

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Background:There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A -0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis. Keywords: Bronchiolitis, hypertonic saline, infant Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633:193-7 Comparing Bronchiolitis is the most frequent viral lower respiratory tract infection seen in infancy period characterized by cough, wheezing and tachypnea. Bronchiolitis is the major reason of infant hospitalization in both developed and developing countries. Although it is common there is no current standard treatment. Supportive care is the only evidence based treatment option (1,2). Many studies focused on testing the effects of bronchodilators such as β2-agonsits (3), epinephrine (4), glucocorticoids (5) and magnesium sulfate (6) with controversial results.There exists the first necrosis of the respiratory epithelium in bronchiolitis. Following by the fact that, exaggerated mucus production occurs due to the proliferation of goblet cells. On the other hand epithelial regeneration with nonciliated cells happens thus decreasing mucociliary clearance. Lymphocytic infiltration may result in submucosal edema (7). Johnson et al. (7) demonstrated that, airway obstruction in bronchiolitis was because of epithelial and inflammatory cell debris. And they did not observe bronchial smooth muscle constriction. This can explain why bronchodilator therapy is not effective in bronchiolitis. Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17). Thus,

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A Randomized Trial of Nebulized 3% Hypertonic Saline With Epinephrine in the Treatment of Acute Bronchiolitis in the Emergency Department

Cited by 88 publications

References 26 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

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

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