Effect of Nebulized 3% Hypertonic Saline on Intensive Care Unit Admission Rates of Infants with Moderate Acute Bronchiolitis

Abstract

Objectives: To investigate whether the use of nebulized 3% hypertonic saline in infants hospitalized for acute bronchiolitis reduces their rate of pediatric intensive care unit (PICU) admission, the mean length of PICU stay and total hospital stay.Methods: Cross-sectional study including 626 infants hospitalized for moderate acute bronchiolitis comparing a group receiving nebulized 3% hypertonic saline (HS group) between September 2011 and May 2014 (n=320), with a historic control group treated with normal saline (NS group) between September 2007 and May 2010 (n=306) independently of the concomitant use of bronchodilators.Results: Overall hospital stay including days at PICU, was significantly reduced in HS group (4 days (0-46) vs 5 days (1-73); p<0.0001). However, we did not find a significant reduction in PICU admission rate in the HS group (p=0.115), neither in the length of stay (LOS) in PICU (5 days (1-30) vs 6 days (1-26); p=0.402). Half as many admission were observed in patients with risk factors of severe disease in HS group (6.5% of those with risk factors vs 3.1% of those without risk factors), although this failure to find a difference (p=0.136). Conclusions:Treatment with nebulized 3% hypertonic saline was not accompanied by a reduction in PICU admission. There was no difference in PICU length of stay in infants with acute bronchiolitis, and admission rates in infants with risk factors for serious bronchiolitis; it was also associated with a significantly shorter mean hospital stay.

Benefits of the humidified low‐flow oxygen therapy in infants with mild–moderate bronchiolitis

“…Thus, humidification in low‐flow oxygen therapy should be recommended as a regular clinical practice, as this viral infection is widespread and highly prevalent. In addition, our results may be generalisable to other clinical scenarios in Spain where the management of infants with bronchiolitis is very similar, such as in bronchodilators nebulised with 3% hypertonic saline and when antibiotics are also prescribed (Flores‐González et al., , ). In other countries, clinicians also prescribe antibiotics, bronchodilators and corticosteroids, with examples found in Italy (De Brasi et al., ) or Finland (Elenius et al., ), despite the fact that administering these treatments has not been shown to have conclusive benefits (American Academy of Pediatrics, ).…”

“…(). HR is considered a distress indicator in some instruments assessing bronchiolitis severity, including the BROSJOD score and other generally accepted measures like the Wood‐Downes Clinical Scoring System, modified by Ferrés (Flores‐González et al., ). When these instruments are used, lower HR generally contributes to lower scores and thus to decreased severity and improvements in infants’ clinical evolution.…”