Nebulized 3% Hypertonic Saline Solution Treatment in Ambulatory Children with Viral Bronchiolitis Decreases Symptoms

Sarrell, E. Michael; Tal, Guy; Witzling, Michaela; Someck, Eli; Houri, Sion; Cohen, Herman Avner; Mandelberg, Avigdor

doi:10.1378/chest.122.6.2015

Cited by 114 publications

(123 citation statements)

References 34 publications

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“…Our data confirm previous evidence (8-10, 14) revised in recent reviews on the effectiveness of nebulized HS as treatment for bronchiolitis in infants (15,16). Four trials involving 254 infants were considered (8)(9)(10)14), showing that nebulized 3% HS effectively determined a shorter mean length of (15,16). The findings on the clinical scores were more relevant among outpatients than inpatients, probably due to the reduced severity of the disease.…”

Section: Discussionsupporting

confidence: 88%

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: Discussionsupporting

confidence: 88%

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%

“…6,11,16 However, in both inpatient and outpatient studies, an improvement in clinical scores was observed by study day 1. 15,16,20 Moreover, because bronchiolitis tends to be a selflimiting illness, we felt that any improvement noted after 24 hours of supportive care might reflect the natural course of disease. The challenge in comparing these trials with our results is the heterogeneity of study design, respiratory assessment tools, and frequency and duration of inhaled therapy.…”

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%

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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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“…The time spent caring for children was similar in all groups and parents were unaware of their child's group allocation. The same score was used in previous studies involving the same patient population and has been demonstrated to be a reliable tool for evaluating and validating clinical outcome [16][17][18] (Table1).…”

Section: Methodsmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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Nebulized 3% Hypertonic Saline Solution Treatment in Ambulatory Children with Viral Bronchiolitis Decreases Symptoms

Cited by 114 publications

References 34 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

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

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