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Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review
Linjie Zhang1, Raúl A Mendoza-Sassi2, Terry P Klassen3
1Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; lzhang@furg.br linjie.zhang@pq.cnpq.br.
Insights
Nebulized hypertonic saline (HS) offers a safe and effective treatment for infants with acute bronchiolitis, potentially reducing hospital stays and improving clinical scores. This approach provides a valuable alternative to standard supportive care for this common respiratory illness.
Area of Science:
- Pediatric Respiratory Medicine
- Critical Care Medicine
- Evidence-Based Medicine
Background:
- Acute bronchiolitis is a common viral respiratory infection in infants, primarily managed with supportive care.
- Current treatment strategies for acute bronchiolitis lack specific targeted therapies, highlighting the need for effective interventions.
Purpose of the Study:
- To evaluate the efficacy and safety of nebulized hypertonic saline (HS) as a treatment for acute bronchiolitis in infants.
- To compare nebulized HS with standard care or 0.9% saline in terms of clinical outcomes and safety.
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials were conducted.
- Databases searched included PubMed and the Virtual Health Library up to May 2015.
- Included studies compared nebulized HS with 0.9% saline or standard treatment in infants with acute bronchiolitis.
Main Results:
- Nebulized HS significantly reduced length of hospital stay for inpatients (MD -0.45 days).
- Inpatients receiving HS showed significantly lower posttreatment clinical scores in the first three days.
- Outpatients treated with nebulized HS experienced a 20% reduced risk of hospitalization compared to 0.9% saline.
- No significant adverse events were associated with nebulized HS inhalation.
Conclusions:
- Nebulized hypertonic saline (HS) is a safe and potentially effective treatment for infants diagnosed with acute bronchiolitis.
- The findings suggest HS can improve clinical outcomes and reduce healthcare utilization in this patient population.
- Moderate quality of evidence indicates potential benefits, though further research may be warranted due to study limitations.
Background And Objective:
The mainstay of treatment for acute bronchiolitis remains supportive care. The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis.
Methods:
Data sources included PubMed and the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information up to May 2015. Studies selected were randomized or quasi-randomized controlled trials comparing nebulized HS with 0.9% saline or standard treatment.
Results:
We included 24 trials involving 3209 patients, 1706 of whom received HS. Hospitalized patients treated with nebulized HS had a significantly shorter length of stay compared with those receiving 0.9% saline or standard care (15 trials involving 1956 patients; mean difference [MD] -0.45 days, 95% confidence interval [CI] -0.82 to -0.08). The HS group also had a significantly lower posttreatment clinical score in the first 3 days of admission (5 trials involving 404 inpatients; day 1: MD -0.99, 95% CI -1.48 to -0.50; day 2: MD -1.45, 95% CI -2.06 to -0.85; day 3: MD -1.44, 95% CI -1.78 to -1.11). Nebulized HS reduced the risk of hospitalization by 20% compared with 0.9% saline among outpatients (7 trials involving 951 patients; risk ratio 0.80, 95% CI 0.67-0.96). No significant adverse events related to HS inhalation were reported. The quality of evidence is moderate due to inconsistency in results between trials and study limitations (risk of bias).
Conclusions:
Nebulized HS is a safe and potentially effective treatment of infants with acute bronchiolitis.
