title: Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics, Royal Victoria Hospital, Barrie, Ontario, Canada. briankuzik@hotmail.com
authors.forename: Brian A
authors.initials: BA
authors.lastname: Kuzik
authors.forename: Michael P
authors.initials: MP
authors.lastname: Flavin
authors.forename: Steven
authors.initials: S
authors.lastname: Kent
authors.forename: David
authors.initials: D
authors.lastname: Zielinski
authors.forename: Charisse W
authors.initials: CW
authors.lastname: Kwan
authors.forename: Adetayo
authors.initials: A
authors.lastname: Adeleye
authors.forename: Bjorn C
authors.initials: BC
authors.lastname: Vegsund
authors.forename: Carlo
authors.initials: C
authors.lastname: Rossi
mesh_terms: D000280:Administration, Inhalation; D001990:Bronchiolitis, Viral / Q000188:drug therapy*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D010343:Patient Admission / Q000706:statistics & numerical data; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012462:Saline Solution, Hypertonic