Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants.
OBJECTIVE
To compare the efficacy and safety of 5%, 3%, and 0.9% saline solution for treating acute bronchiolitis in the prehospital setting.


METHODS
This was a double-blind trial including consecutive infants aged <18 months treated in an urban urgent care setting. A total of 165 patients were randomized to receive nebulized 5%, 3%, or 0.9% (normal) saline with epinephrine every 4 hours. The primary efficacy outcome was bronchiolitis severity score improvement at 48 hours (chi2 analysis). Scores and oxygen saturation immediately before and after each treatment were recorded to assess safety.


RESULTS
A total of 187 previously healthy infants (median age, 3.1 months) diagnosed with bronchiolitis were enrolled. Positivity for respiratory syncytial virus was similar in the 3 treatment groups (mean, 56%). At 48 hours, the mean severity score for the 5% saline group was 3.69+/-1.09, and that for the 0.9% saline group was 4.12+/-1.11 (P=.04; difference, 0.43, 95% confidence interval for the difference, 0.02-0.88). The mean severity score for the 3% saline group was intermediate at 4.00+/-1.22. Revisit rates after discharge were similar in the 3 treatment groups. No adverse reactions or other safety concerns were identified.


CONCLUSIONS
Nebulization with 5% hypertonic saline is safe, can be widely generalizable, and may be superior to current treatment for early outpatient treatment of bronchiolitis.
Al-Ansari
Khalid
K
Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.
Sakran
Mahmoud
M
Davidson
Bruce L
BL
El Sayyed
Rafah
R
Mahjoub
Hella
H
Ibrahim
Khalid
K
D000208:Acute Disease; D000280:Administration, Inhalation; D000553:Ambulatory Care; D001988:Bronchiolitis / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000188:drug therapy; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*
D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic