Nebulized Hypertonic Saline Treatment Reduces Both Rate and Duration of Hospitalization for Acute Bronchiolitis in Infants: An Updated Meta-analysis

Abstract Introduction: Acute bronchiolitis is the most common lower respiratory infection in children. It is particularly prone to dyspnea among children under two years old. Inhaled hypertonic saline (HS) has recently been shown to be a favorable therapy, because of its facility to draw fluid from the submucosa and adventitial spaces, decreasing airway edema. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of vapor treatment among children with bronchiolitis.Methods: A systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis.Results: In total, 4186 children from 32 publications were included. Compared to the control group, the HS group exhibited significantly reducing the level of severity of respiratory distress, included studies used the Clinical Severity Score (95% CI −1.15, −0.27, I² = 73%) and Respiratory Distress Assessment Instrument (95% CI −0.95, −0.26, I²= 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (95% CI −0.86, −0.32, I²= 81%). Conclusion: We conclude that nebulized with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigor randomize controlled trails with large sample size are needed.

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Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis

JAMA Pediatrics ◽

10.1001/jamapediatrics.2017.1333 ◽

2017 ◽

Vol 171 (8) ◽

pp. e171333 ◽

Cited By ~ 20

Author(s):

François Angoulvant ◽

Xavier Bellêttre ◽

Karen Milcent ◽

Jean-Paul Teglas ◽

Isabelle Claudet ◽

...

Keyword(s):

Hypertonic Saline ◽

Emergency Departments ◽

Hospitalization Rate ◽

Acute Bronchiolitis ◽

Saline Treatment

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A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20212468 ◽

2021 ◽

Vol 8 (7) ◽

pp. 1176

Author(s):

Pradhyumn Pamecha ◽

Sanjay Mandot

Keyword(s):

Randomized Controlled Trial ◽

Side Effects ◽

Respiratory Tract ◽

Hypertonic Saline ◽

Controlled Trial ◽

Acute Bronchiolitis ◽

Randomized Controlled ◽

Duration Of Hospitalization ◽

Nebulized Epinephrine ◽

Double Blinded

Background: Acute Bronchiolitis is an infection of the lower respiratory tract, most frequently caused by the respiratory syncytial virus. It is one of the most common cause of hospital admission for respiratory tract illnesses in infants. This is a double blinded randomized controlled trial, conducted to compare the therapeutic efficacy of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis.Methods: It was a double blinded randomized controlled trial conducted over a period of 18 months (January 2019-June 2020) in infants aged 2 months to 1 year diagnosed with acute bronchiolitis. All eligible patients were randomly assigned to one of two groups: Group I received inhalation of Epinephrine; Group II received inhalation of Hypertonic (3%) Saline. Patients in each group received four treatments on each day of hospitalization, delivered at 6 hourly intervals. Monitoring parameters for improvement or worsening of the condition were measured and recorded on admission and then at 24 hourly intervals using the clinical score described by Wang, et al for the first three days of treatment.Results: Among the infants treated with hypertonic saline, there was a significant decrease in the post inhalation respiratory score on day 2 and day 3 as compared to the infants treated with epinephrine. There was a significant difference in duration of hospitalization between the two groups as duration of hospitalization in infants was less in hypertonic saline group as compared to the epinephrine group. Hypertonic saline also showed significantly lesser side effects post inhalation when compared to epinephrine. The difference was statistically significant with p<0.0001.Conclusions: The study concluded that the use of nebulized hypertonic saline in infants aged 2 months to 12 months, provides evidence for its role as an efficient treatment modality in the treatment of acute bronchiolitis. The study also found that nebulized epinephrine had more side effects associated with it.

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Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials

BMC Pediatrics ◽

10.1186/s12887-020-02314-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chia-Wen Hsieh ◽

Chiehfeng Chen ◽

Hui-Chuan Su ◽

Kee-Hsin Chen

Keyword(s):

Respiratory Distress ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Hypertonic Saline ◽

Saline Solution ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Acute Bronchiolitis ◽

Randomized Controlled

Abstract Background Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of treatment with nebulized HS among children with bronchiolitis. Methods A systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis. Results There were 4186 children from 32 publications included. Compared to the control group, the HS group exhibited significant reduction of severity of respiratory distress, included studies used the Clinical Severity Score (n = 8; MD, − 0.71; 95% CI, − 1.15 to − 0.27; I2 = 73%) and full stop after Respiratory Distress Assessment Instrument (n = 5; MD, − 0.60; 95% CI, − 0.95 to − 0.26; I2 = 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (n = 20; MD, − 0.54; 95% CI, − 0.86 to − 0.23; I2 = 81%). Conclusions We conclude that nebulization with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigorous randomized controlled trials with large sample size are needed.

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Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: a systematic review and meta-analysis

10.22541/au.162113107.72098189/v1 ◽

2021 ◽

Author(s):

Renan Pereira ◽

Versiéri Almeida ◽

Mariana Zambrano ◽

Linjie Zhang ◽

Sérgio Amantéa

Keyword(s):

Systematic Review ◽

Combination Therapy ◽

Hypertonic Saline ◽

Safety Profile ◽

Meta Analysis ◽

Clinical Severity ◽

Acute Bronchiolitis ◽

Severity Scores ◽

Mean Differences ◽

Nebulized Epinephrine

Management of acute bronchiolitis remains controversial due to lack of strong evidence-based data. Nebulized epinephrine and hypertonic saline have been studied in infants with bronchiolitis, with conflicting results. This systematic review and meta-analysis aimed to evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO2) and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized. 18 trials were systematically selected and 16 of them contributed for the meta-analysis (1,756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of – 0.35 days, 95% CI -0.62 to -0.08, p = 0.01, I2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 hours and 72 hours after the admission (SMD of -0.35, 95% CI -0.62 to -0.09, p = 0.008, I2 = 41% and SMD of -0.27, 95% CI -0.50 to -0.04, p = 0.02, I2 = 0%, respectively). No difference in SaO2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient. In conclusion, nebulized epinephrine plus HS may be considered as a safe, cheap and efficient alternative for decreasing LOS and CSS in infants with acute bronchiolitis, especially on those who require more than 48 hours of hospitalization.

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