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Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial

Published online by Cambridge University Press:  21 May 2015

Brian A. Kuzik*
Affiliation:
Department of Paediatrics, Royal Victoria Hospital, Barrie, Ont.
Michael P. Flavin
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Steven Kent
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
David Zielinski
Affiliation:
Department of Pediatrics, Hotel Dieu Hospital, Queen's University, Kingston, Ont.
Charisse W. Kwan
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Adetayo Adeleye
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Bjorn C. Vegsund
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
Carlo Rossi
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
*
208–1 Quarry Ridge Rd., Barrie ON L4M 7G1; [email protected]

Abstract

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Objective:

We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days.

Methods:

Children under the age of 2 years presenting with moderately severe viral bronchiolitis to the emergency department of 4 general hospitals from November 2008 to March 2009 were randomly assigned to receive 3 consecutive 4-mL doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group) in a double blind fashion, each coadministered with 1 mg salbutamol. Outcome measures included the difference in hospital admission rate and changes in respiratory distress scores.

Results:

A total of 81 children (mean age 8.9 mo, range 0.7–22 mo) were assessed over 88 visits on an intention-to-treat basis. No statistically significant differences were found between treatment groups. Children in the HS group had a nonsignificant trend toward greater improvement compared with NS controls with a same-day admission rate of 18% (95% confidence interval [CI] 9%–32%) versus 27% (95% CI 16%–42%), respectively. Respiratory Assessment Change Scores (RACS) favoured the HS group over NS controls (mean RACS 4.7 [95% CI 3.6–5.8] v. 3.7 [95% CI 2.5–4.9], respectively), although the CIs overlap and these differences were not statistically significant.

Conclusion:

The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Glezen, P, Denny, FW. Epidemiology of acute lower respiratory disease in children. N Engl J Med 1973;288:498505.Google Scholar
2.Ray, CG, Minnich, LL, Holberg, CJ, et al. Respiratory syncytial virus-associated lower respiratory illnesses: possible influence of other agents. Pediatr Infect Dis J 1993;12:15–9.CrossRefGoogle ScholarPubMed
3.Pelletier, AJ, Mansbach, JM, Camargo, CA. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics 2006;118:2418–23.Google Scholar
4.Welliver, JR, Welliver, RC. Bronchiolitis. Pediatr Rev 1993; 14:134–9.CrossRefGoogle ScholarPubMed
5.Welliver, TP, Garofalo, RP, Hosakote, Y, et al. Severe human lower respiratory tract illness causedby respiratory syncytial virus and influenza virus is characterized by the absence of pulmonary cytotoxic lymphocyte responses. J Infect Dis 2007;195:1126–36.CrossRefGoogle Scholar
6.Johnson, JE. The histopathology of fatal untreated human respiratory syncytial virus infection. Mod Pathol 2007;20:108–19.Google Scholar
7.Kuzik, BA, Al Qadhi, SA, Kent, S, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr 2007;151:266–70.CrossRefGoogle ScholarPubMed
8.Corneli\, HM, Zorc, JJ, Mahajan, P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357:331–9.Google Scholar
9.AmericanAcademy of Pediatrics Subcommittee on the Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118:1774–93.Google Scholar
10.Yanney, M, Vyas, H. The treatment of bronchiolitis. Arch Dis Child 2008;93:793–8.Google Scholar
11.Sarrell, EM, Tal, G, Witzling, M, et al. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest 2002;122:2015–20.Google Scholar
12.Tal, G, Cesar, K, Oron, A, et al. Hypertonic saline/epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalizations stay: 2 years experience. Isr Med Assoc J 2006;8:169–73.Google ScholarPubMed
13.Zhang, L, Mendoza-Sassi, RA, Wainwright, C, et al. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2008;CD006458.CrossRefGoogle ScholarPubMed
14.Robinson, M, Hemming, AL, Regnis, JA, et al. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis. Thorax 1997;52:900–3.Google Scholar
15.Tomooka, LT, Murphy, C, Davidson, TM. Clinical study and literature review of nasal irrigation. Laryngoscope 2000; 110:1189–93.Google Scholar
16.Lowell, DI, Lister, G, VonKoss, H, et al. Wheezing in infants: the response to epinephrine. Pediatrics 1987;79:939–45.Google Scholar
17.Amirav, I, Balanov, I, Gorenberg, M, et al. Nebulizer hood compared to mask in wheezy infants: aerosol therapy without tears! Arch Dis Child 2003;88:719–23.Google Scholar
18.Ralston, S, Hartenberger, C, Anaya, T, et al. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol 2005;40:292–9.Google Scholar
19.Menon, K, Sutcliffe, T, Klassen, TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995;126:1004–7.CrossRefGoogle ScholarPubMed
20.Williams, PV. Inhalation bronchoprovocation in children. Immunol Allergy Clin North Am 1998;18:149–65.Google Scholar
21.Calogero, C, Sly, PD. Acute viral bronchiolitis: To treat or not to treat — that is the question. J Pediatr 2007;151:235–7.CrossRefGoogle ScholarPubMed
22.Grewal, S, Ali, S, McConnell, MD, et al. A randomized trial of nebulized 3% hypertonic saline withepinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med 2009;163:1007–12.CrossRefGoogle Scholar
23.Anil, AB, Anil, M, Saglam, AB, et al. High volume normal saline alone is as effective as nebulizedsalbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol 2010;45:41–7.CrossRefGoogle ScholarPubMed
24.Plint, AC, Johnson, DW, Patel, HM, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009;360:2079–89.Google Scholar
25.Schuh, S, Coates, AL, Binnie, R, et al. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr 2002;140:2732.Google Scholar
26.Kellner, JD, Ohlsson, A, Gadomski, AM, et al. Efficacy of bronchodilator therapy in bronchiolitis. Arch Pediatr Adolesc Med 1996;150:1166–72.CrossRefGoogle ScholarPubMed
27.Gadomski, AM, Bhasale, AL. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2006;3:CD001266.Google Scholar
28.Mansbach, JM, Clark, S, Christopher, NC, et al. Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics 2008;121:680–8.Google Scholar
29.Brand, PLP, Baraldi, E, Bisgaard, H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096–110.CrossRefGoogle Scholar
30.Henderson, J, Granell, R, HeronJ, J,et al. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax 2008;63:974–80.Google Scholar
31.Subbarao, P, Balkovec, S, Solomon, M, et al. Pilot study of safety and tolerability of inhaled hypertonic saline in infants with cystic fibrosis. Pediatr Pulmonol 2007;42:471–6.Google Scholar