Nebulized hypertonic saline solution for acute bronchiolitis in infants
Sübutlu məlumatların xülasələri
01.02.2018 • Sonuncu dəyişiklik 01.02.2018
Editors
Nebulized hypertonic saline appears to modestly reduce length of stay among infants hospitalized with acute bronchiolitis and improve clinical severity score compared to nebulized 0.9% saline.
The quality of evidence is downgraded by inconsistency (variability in results).
Summary
A Cochrane review included 28 studies with a total of 4 195 infants with acute bronchiolitis (17 inpatient studies, n=2 028; 2 outpatient studies, n=194; 7 emergency department studies, n=1 873; 1 outpatient and emergency department study, n=100). The mean age of participants was from 2.6 to 12.5 months. Treatment regimens of nebulized hypertonic saline (volume, interval of administration, addition of bronchodilator, and treatment duration) varied across studies.
Hospitalized infants treated with nebulized hypertonic saline had shorter mean length of hospital stay (MD -0.41 days, 95% CI -0.75 to -0.07, statistical heterogeneity I² = 79%; 17 studies, n=1 867), and infants who received hypertonic saline also had lower post-inhalation clinical scores in the first 3 days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36; day 2: MD -1.28, 95% CI -1.91 to -0.65; day 3: MD -1.43, 95% CI -1.82 to -1.04) compared to those treated with nebulized 0.9% saline.
Nebulized hypertonic saline reduced the risk of hospitalization compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; 8 studies, n=1 723).
Twenty-four studies presented safety data: 13 studies (n=1 363) did not report any adverse events, and 11 studies (n=2 360) reported at least one adverse event, most of which were mild and resolved spontaneously.
A Cochrane review
included studies with a total of infants with mild to moderate acute viral bronchiolitis (500 inpatients, 65 outpatients, and 525 emergency department patients).
The mean age of participants varied from 2.6 to 12.5 months. Bronchodilators were added to the study solution
per protocol in 9 trials; in one trial, the study protocol defined the use of nebulised 3% saline alone, but bronchodilators were added into the study solution in 60% of the treatments by attending physicians; and only 2 trials used 3% saline alone. A total of 560 patients received hypertonic saline (3% saline n = 503; 5% saline n = 57). Patients treated with nebulized 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulized 0.9% saline (MD –1.15 days, 95% CI –1.49 to –0.82). The hypertonic saline group also had a significantly lower post-inhalation clinical score than the 0.9% saline group in the first three days of treatment (day 1: MD –0.88, 95% CI –1.36 to –0.39; day 2: MD –1.32, 95% CI –2.00 to –0.64; day 3: MD –1.51, 95% CI –1.88 to –1.14). The effects of improving clinical score were observed in both outpatients and inpatients. Four emergency department-based trials failed to show significant short-term effects (30 to 120 minutes) of up to three doses of nebulized 3% saline in improving clinical score and oxygen saturation. No signifiant adverse events related to hypertonic saline inhalation were reported.
Ədəbiyyat
- Zhang L, Mendoza-Sassi RA, Wainwright C et al. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2017;(12):CD006458. .