title: 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial.
abstract: BACKGROUND
  Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated.
  
  
  METHODS
  We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay.
  
  
  RESULTS
  At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant.
  
  
  CONCLUSIONS
  In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, TN 38103. jay.pershad@mlh.org.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Jacobs
authors.forename: Megan
authors.initials: M
authors.lastname: Foster
authors.forename: Jim
authors.initials: J
authors.lastname: Wan
authors.forename: Jay
authors.initials: J
authors.lastname: Pershad
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D001990:Bronchiolitis, Viral / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic; D004837:Epinephrine
keywords: 7% hypertonic saline; acute bronchiolitis