The role of nebulized hypertonic saline in the management of acute bronchiolitis

Abstract

Background Acute bronchiolitis is the most frequent lower respiratory tract infection in infants and the most frequent cause of hospitalization in this age group. It places enormous strains on pediatric inpatient services and pediatric ICUs, and despite the growing understanding of its pathogenesis, currently available therapies have failed to show consistent benefit, and supportive care remains the mainstay of bronchiolitis therapy. It is suggested that hypertonic saline nebulization may be useful in making secretions less viscous and promoting their excretion, thereby resulting in clinical improvement, and over the past decade, a growing number of randomized trials have suggested that early and repeated doses of nebulized 3% hypertonic saline improve clinical outcomes in hospitalized children compared with 0.9% normal saline. Objectives The current study aimed to study the safety and efficacy of nebulized 3% hypertonic saline in hospitalized infants with a clinical diagnosis of bronchiolitis. Patients and methods This double-blind, randomized controlled trial was conducted on 110 infants who were admitted to Alexandria University Children’s Hospital with a clinical diagnosis of acute bronchiolitis. The diagnosis of bronchiolitis was based on clinical evaluation. Patients were randomly allocated into two groups: one group received nebulized 3% hypertonic saline with 2.5-mg salbutamol at intervals of 4 h, whereas the second group received nebulized 0.9% normal saline with 2.5-mg salbutamol at intervals of 4 h. Results There was no significant difference in the clinical severity score between the two studied groups in all days of admission, except for mild improvement on the second and third days of admission, yet it was not sufficient enough to make the patients eligible for discharge. Furthermore, there was no significant difference in length of hospital stay among infants who received hypertonic saline. Complications of nebulized hypertonic saline, namely, vomiting, agitation, exacerbation of cough, cyanosis, and apnea, were similar to normal saline. Conclusion The use of nebulized 3% hypertonic saline in hospitalized infants with bronchiolitis is considered safe, but when compared with 0.9% normal saline, it did not improve the clinical severity score nor shorten the length of hospital stay in hospitalized infants with bronchiolitis.