Normal saline and lung recruitment with paediatric endotracheal suction (NARES): A pilot, factorial, randomised controlled trial

Abstract Objectives: To evaluate the effect of intraperitoneal normal saline instillation (INSI) of 15 mL/kg body weight at the end of a gynaecological laparoscopic procedure on postoperative pain. Design: Randomised controlled trial. Setting: Teaching/University Hospital in Kuala Lumpur, Malaysia. Participants: Patients aged 18-55 years, with American Society of Anaesthesiologists (ASA) classification I–II, scheduled for an elective gynaecological laparoscopic procedure for a benign cause.Intervention: The patients were randomly allocated to two groups. In the intervention group, 15 mL/kg body weight of normal saline was instilled intraperitoneally, while the control group received the conventional combination of open laparoscopic trocar valves with gentle abdominal pressure to remove the retained carbon dioxide. Main outcome measures: The primary outcomes were the mean pain score for the shoulder and upper abdominal pain at 24 h, 48 h, and 72 h postoperatively. Results: A total of 68 women completed the study, including 34 women in each group. There was no difference in the shoulder pain score at 24 h, 48 h, and 72 h postoperatively. However, a significant improvement in the upper abdominal pain score after 42 h (95% confidence interval (CI) 0.34-1.52, p=0.019) and 72 h (95% CI 0.19-0.26, p=0.007) postoperatively were observed. Conclusions: INSI of 15 mL/kg body weight does not lower postoperative shoulder pain compared to no fluid instillation. A modest pain score improvement was observed in the upper abdominal area at 42 h and 72 h after surgery. An INSI of up to 30 mL/kg body weight may be required to eliminate shoulder pain. Care must be taken before administering a higher amount of INSI, considering the potential risk of peritoneal adhesions. Clinical Registration: ISRCTN Identifier: 87898051 (Date: 26 June 2019) https://doi.org/10.1186/ISRCTN87898051

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The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial

European Respiratory Journal ◽

10.1183/09031936.00159613 ◽

2014 ◽

Vol 44 (4) ◽

pp. 913-921 ◽

Cited By ~ 37

Author(s):

Jasmijn Teunissen ◽

Anne H.J. Hochs ◽

Anja Vaessen-Verberne ◽

Annemie L.M. Boehmer ◽

Carien C.J.M. Smeets ◽

...

Keyword(s):

Sodium Chloride ◽

Randomised Controlled Trial ◽

Hospital Stay ◽

Hypertonic Saline ◽

Normal Saline ◽

Controlled Trial ◽

Tube Feeding ◽

Length Of Hospital Stay ◽

Supplemental Oxygen ◽

Randomised Controlled

Bronchiolitis is a common disorder in young children that often results in hospitalisation. Except for a possible effect of nebulised hypertonic saline (sodium chloride), no evidence-based therapy is available. This study investigated the efficacy of nebulised 3% and 6% hypertonic saline compared with 0.9% hypertonic saline in children hospitalised with viral bronchiolitis.In this multicentre, double-blind, randomised, controlled trial, children hospitalised with acute viral bronchiolitis were randomised to receive either nebulised 3%, 6% hypertonic saline or 0.9% normal saline during their entire hospital stay. Salbutamol was added to counteract possible bronchial constriction. The primary endpoint was the length of hospital stay. Secondary outcomes were need for supplemental oxygen and tube feeding.From the 292 children included in the study (median age 3.4 months), 247 completed the study. The median length of hospital stay did not differ between the groups: 69 h (interquartile range 57), 70 h (IQR 69) and 53 h (IQR 52), for 3% (n=84) and 6% (n=83) hypertonic saline and 0.9% (n=80) normal saline, respectively, (p=0.29). The need for supplemental oxygen or tube feeding did not differ significantly. Adverse effects were similar in the three groups.Nebulisation with hypertonic saline (3% or 6% sodium chloride) although safe, did not reduce the length of stay in hospital, duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis.

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