Prevention of VAP Using Hypertonic Saline Nebulization in NICU: A Randomized Controlled Trial

To evaluate the efficacy and safety of hypertonic saline (HS) nebulization in reducing the occurrence of ventilator associated pneumonia (VAP) by comparison of modified Clinical Pulmonary Infection Score (mCPIS) in HS nebulized and non-nebulized newborns.

A randomized controlled study with 1:1 participant allocation ratio was conducted in a tertiary centre in North India. Neonates who received mechanical ventilation at the centre were included. Those who had been intubated for >12 hours at outside hospitals were excluded. The study group received nebulization with HS for seven days or till extubation (whichever was earlier). Both groups were compared in terms of occurrence of VAP and mCPIS. mCPIS ≥ 6 was used to suggest VAP. VAP was confirmed by a positive blood culture in ventilated newborns with clinicoinvestigative features of VAP.

A total of 143 neonates were analyzed in each group. VAP rate (per 1000 mechanical ventilation-days) in the HS nebulization and the control groups were 36.72 and 51.51, respectively; P = 0.031. A 33.52% reduction in the rate of VAP was observed due to HS nebulization. [RR (95% CI) 0.67 (0.47, 0.95), P = 0.022]. The mean (SD) mCPIS in HS group was 5.22 (0.88) compared to 5.94 (1.07) in the control group; P = 0.030. Only 5.5% neonates in the intervention group developed wheezing.

Nebulization with HS reduces the incidence of VAP in ventilated newborns without significant side effects.