title: Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review.
abstract: OBJECTIVE
  The mainstay of treatment for acute bronchiolitis remains supportive care. The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis.
  
  
  METHODS
  Data sources included PubMed and the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information up to May 2015. Studies selected were randomized or quasi-randomized controlled trials comparing nebulized HS with 0.9% saline or standard treatment.
  
  
  RESULTS
  We included 24 trials involving 3209 patients, 1706 of whom received HS. Hospitalized patients treated with nebulized HS had a significantly shorter length of stay compared with those receiving 0.9% saline or standard care (15 trials involving 1956 patients; mean difference [MD] -0.45 days, 95% confidence interval [CI] -0.82 to -0.08). The HS group also had a significantly lower posttreatment clinical score in the first 3 days of admission (5 trials involving 404 inpatients; day 1: MD -0.99, 95% CI -1.48 to -0.50; day 2: MD -1.45, 95% CI -2.06 to -0.85; day 3: MD -1.44, 95% CI -1.78 to -1.11). Nebulized HS reduced the risk of hospitalization by 20% compared with 0.9% saline among outpatients (7 trials involving 951 patients; risk ratio 0.80, 95% CI 0.67-0.96). No significant adverse events related to HS inhalation were reported. The quality of evidence is moderate due to inconsistency in results between trials and study limitations (risk of bias).
  
  
  CONCLUSIONS
  Nebulized HS is a safe and potentially effective treatment of infants with acute bronchiolitis.
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; lzhang@furg.br linjie.zhang@pq.cnpq.br.
authors.forename: Linjie
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil;
authors.forename: Raúl A
authors.initials: RA
authors.lastname: Mendoza-Sassi
authors.affiliation: Manitoba Institute of Child Health; Children's Hospital Research Institute of Manitoba; Department of Pediatrics, University of Manitoba, Winnipeg, Canada; and.
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.affiliation: Queensland Children's Medical Research Institute; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital; School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Wainwright
mesh_terms: D000208:Acute Disease; D001988:Bronchiolitis / Q000628:therapy*; D006801:Humans; D007223:Infant; D009330:Nebulizers and Vaporizers; D016032:Randomized Controlled Trials as Topic; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*
chemical_list: D012462:Saline Solution, Hypertonic