3% nebulized hypertonic saline equals standard supportive care in children with moderate or severe bronchiolitis

Reference

Jaquet-Pilloud R, Verga ME, Russo M, Gehri M, Pauchard JY. Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial. Arch Dis Child 2020;105(3):236-240.

Synopsis

This study took place in 2 hospitals in Switzerland. The researchers randomized children aged 6 weeks to 24 months who came to the emergency department with moderate to severe bronchiolitis (baseline Wang score: 5 - 12) to receive standard care (n = 61) or standard care plus 3% nebulized saline (hypertonic saline; n = 60) administered every 6 hours. Standard care consisted of nasal suctioning, managing fluids and electrolytes, and supplementing oxygen when needed. If a child demonstrated signs of respiratory failure, the protocol called for administering nebulized epinephrine. The researchers transferred children to the intensive care unit if they did not improve after 3 treatments in an hour. After randomization, the researchers excluded 2 patients: One child with pneumonia shouldn't have been enrolled and the other experienced decompensation of an underlying neurologic disorder. The groups were comparable at baseline on key factors that could influence outcomes. The mean length of stay for children treated with hypertonic saline was 47 hours compared with 50.4 hours for those treated with standard care. This difference was not statistically significant and the study was powerful enough to detect a 1-day difference in length of stay. The authors also report no statistically significant differences in oxygen therapy, rescue nebulizers, or readmissions. Three children, all in the standard care group, were transferred to the intensive care unit but the study wasn't large enough to tell if that was significant.