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Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial

Published online by Cambridge University Press:  21 May 2015

Brian A. Kuzik ,
Michael P. Flavin ,
Steven Kent ,
David Zielinski ,
Charisse W. Kwan ,
Adetayo Adeleye ,
Bjorn C. Vegsund  and
Carlo Rossi
Brian A. Kuzik*
Affiliation:
Department of Paediatrics, Royal Victoria Hospital, Barrie, Ont.
Michael P. Flavin
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Steven Kent
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
David Zielinski
Affiliation:
Department of Pediatrics, Hotel Dieu Hospital, Queen's University, Kingston, Ont.
Charisse W. Kwan
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Adetayo Adeleye
Affiliation:
Department of Pediatrics, Queen's University, Kingston General Hospital, Kingston, Ont.
Bjorn C. Vegsund
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
Carlo Rossi
Affiliation:
Department of Pediatrics, University of British Columbia, Victoria General Hospital, Victoria, BC
*
208–1 Quarry Ridge Rd., Barrie ON L4M 7G1; [email protected]

Abstract

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Objective:

We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days.

Methods:

Children under the age of 2 years presenting with moderately severe viral bronchiolitis to the emergency department of 4 general hospitals from November 2008 to March 2009 were randomly assigned to receive 3 consecutive 4-mL doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group) in a double blind fashion, each coadministered with 1 mg salbutamol. Outcome measures included the difference in hospital admission rate and changes in respiratory distress scores.

Results:

A total of 81 children (mean age 8.9 mo, range 0.7–22 mo) were assessed over 88 visits on an intention-to-treat basis. No statistically significant differences were found between treatment groups. Children in the HS group had a nonsignificant trend toward greater improvement compared with NS controls with a same-day admission rate of 18% (95% confidence interval [CI] 9%–32%) versus 27% (95% CI 16%–42%), respectively. Respiratory Assessment Change Scores (RACS) favoured the HS group over NS controls (mean RACS 4.7 [95% CI 3.6–5.8] v. 3.7 [95% CI 2.5–4.9], respectively), although the CIs overlap and these differences were not statistically significant.

Conclusion:

The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.

Keywords

randomizedasthmawheezingrespiratory syncytial virusrespiratory infectionsalbutamolalbuterolhypertonic salinebronchiolitis
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 6 , September 2010 , pp. 477 - 484
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

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