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Prevention of VAP Using Hypertonic Saline Nebulization in NICU: A Randomized Controlled Trial
Arpit Gupta1, Mukesh Vir Singh1, Rajesh Kumar Yadav1
1Department of Pediatrics, MLN Medical College, Prayagraj, Uttar Pradesh, India.
Indian Pediatrics
|February 6, 2025
Summary
Hypertonic saline nebulization significantly reduced ventilator-associated pneumonia (VAP) in newborns. This intervention lowered VAP rates and modified Clinical Pulmonary Infection Scores (mCPIS) without major side effects.
Area of Science:
- Neonatal critical care
- Respiratory medicine
- Infectious disease prevention
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in neonates requiring mechanical ventilation.
- Effective strategies to reduce VAP incidence are crucial for improving outcomes in critically ill newborns.
Purpose of the Study:
- To assess the efficacy and safety of nebulized hypertonic saline (HS) in preventing VAP among mechanically ventilated neonates.
- To compare the modified Clinical Pulmonary Infection Score (mCPIS) between neonates receiving HS nebulization and those not receiving it.
Main Methods:
- A randomized controlled trial was conducted with 143 neonates per group in a tertiary Indian center.
- The intervention group received HS nebulization for seven days or until extubation.
- VAP occurrence and mCPIS were primary outcome measures, with VAP confirmed by positive blood cultures and clinical features.
Main Results:
- HS nebulization resulted in a 33.52% reduction in VAP rates (36.72 vs. 51.51 per 1000 ventilation-days; P=0.031).
- The mean mCPIS was significantly lower in the HS group (5.22 vs. 5.94; P=0.030).
- Wheezing occurred in only 5.5% of neonates in the HS group, indicating good safety.
Conclusions:
- Nebulization with hypertonic saline is an effective method for reducing VAP incidence in ventilated newborns.
- The treatment is well-tolerated, with minimal adverse effects like wheezing.
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