title: Nebulised hypertonic saline solution for acute bronchiolitis in infants.
abstract: BACKGROUND
  Airway oedema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution may reduce these pathological changes and decrease airway obstruction.
  
  
  OBJECTIVE
  To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute viral bronchiolitis.
  
  
  METHODS
  We searched CENTRAL 2013, Issue 4, OLDMEDLINE (1951 to 1965), MEDLINE (1966 to April week 4, 2013), EMBASE (1974 to May 2013), LILACS (1985 to May 2013) and Web of Science (1955 to May 2013).
  
  
  METHODS
  Randomised controlled trials (RCTs) and quasi-RCTs using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline as a comparator in infants up to 24 months of age with acute bronchiolitis.
  
  
  METHODS
  Two review authors independently performed study selection, data extraction and assessment of risk of bias in included studies. We conducted meta-analyses using the Cochrane statistical package RevMan 5.2. We used the random-effects model for meta-analyses. We used mean difference (MD) and risk ratio (RR) as effect size metrics.
  
  
  RESULTS
  We included 11 trials involving 1090 infants with mild to moderate acute viral bronchiolitis (500 inpatients, five trials; 65 outpatients, one trial; and 525 emergency department patients, four trials). All but one of the included trials were of high quality with a low risk of bias. A total of 560 patients received hypertonic saline (3% saline n = 503; 5% saline n = 57). Patients treated with nebulised 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -1.15 days, 95% confidence interval (CI) -1.49 to -0.82, P < 0.00001). 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, P = 0.0004; day 2: MD -1.32, 95% CI -2.00 to -0.64, P = 0.001; day 3: MD -1.51, 95% CI -1.88 to -1.14, P < 0.00001). The effects of improving clinical score were observed in both outpatients and inpatients. Four emergency department-based trials did not show any significant short-term effects (30 to 120 minutes) of up to three doses of nebulised 3% saline in improving clinical score and oxygen saturation. No significant adverse events related to hypertonic saline inhalation were reported.
  
  
  CONCLUSIONS
  Current evidence suggests nebulised 3% saline may significantly reduce the length of hospital stay among infants hospitalised with non-severe acute viral bronchiolitis and improve the clinical severity score in both outpatient and inpatient populations.
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil. zhanglinjie63@yahoo.com.br.
authors.forename: Linjie
authors.initials: L
authors.lastname: Zhang
authors.forename: Raúl A
authors.initials: RA
authors.lastname: Mendoza-Sassi
authors.forename: Claire
authors.initials: C
authors.lastname: Wainwright
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
mesh_terms: D000208:Acute Disease; D001990:Bronchiolitis, Viral / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D009330:Nebulizers and Vaporizers; D016032:Randomized Controlled Trials as Topic; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*
chemical_list: D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic