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7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial
Jonathan D Jacobs1, Megan Foster, Jim Wan
1Division of Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, TN 38103. jay.pershad@mlh.org.
Insights
Seven percent hypertonic saline (HS) did not significantly improve bronchiolitis severity scores in infants compared to standard saline. This study found no significant differences in hospitalization or length of stay for acute bronchiolitis treatment.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Trials
Background:
- Hypertonic saline (HS) may enhance mucus clearance in infants with acute bronchiolitis.
- Higher HS concentrations (3-5%) show a trend towards improved outcomes compared to 0.9% saline with epinephrine.
- The efficacy of 7% HS in acute bronchiolitis has not been previously studied.
Purpose of the Study:
- To evaluate the effectiveness of 7% HS compared to 0.9% saline with epinephrine in infants with moderate to severe acute bronchiolitis.
- To assess the impact on bronchiolitis severity score (BSS), hospitalization rates, and length of stay.
Main Methods:
- Prospective, double-blind, randomized controlled trial involving 101 infants with acute bronchiolitis.
- Interventions: nebulized 7% HS or 0.9% saline, both with epinephrine.
- Primary outcome: change in BSS; Secondary outcomes: hospitalization rate, discharge timing, and length of stay (ED and inpatient).
Main Results:
- No statistically significant difference in the mean decrease of BSS between the 7% HS and control groups (2.6 vs 2.4).
- Similar rates of hospitalization (42% vs 49%), ED/inpatient length of stay, and early discharge (at 23 hours) between the groups.
Conclusions:
- In moderate to severe acute bronchiolitis, 7% HS with epinephrine does not provide a clinically significant reduction in BSS compared to 0.9% saline with epinephrine.
- The use of 7% HS did not demonstrate significant benefits regarding hospitalization or length of stay in this patient population.
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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