title: Prophylactic Use of Nebulized Hypertonic Saline in Mechanically Ventilated Children: A Randomized Blinded Pilot Study.
abstract: BACKGROUND
  Mucolytic agents, such as nebulized hypertonic saline, may improve airway clearance and shorten the duration of mechanical ventilation, but prospective blinded studies in children undergoing mechanical ventilation are lacking.
  
  
  METHODS
  Children <18 y old who had been intubated for <12 h and had an expected duration of mechanical ventilation of >48 additional h were prophylactically given 3 mL of either nebulized hypertonic saline or placebo (0.9% saline) 4 times/d. The primary outcome was duration of mechanical ventilation. Ventilator parameters and the presence of wheezing were recorded before and after study drug administration.
  
  
  RESULTS
  The duration of mechanical ventilation was significantly longer in children treated with hypertonic saline (208.1 [interquartile range 136.3-319.8] h) versus those treated with placebo (129.5 [interquartile range 74.4-146.1] h) (P = .03 by Wilcoxon rank-sum test). After adjusting for baseline levels of PEEP, the duration of mechanical ventilation did not differ between groups. Mechanical ventilation parameters, including dead space and dynamic compliance, did not differ between measurements taken before study drug administration versus measurements taken after. New onset wheezing following study drug administration was rare (1.0% with hypertonic saline vs 3.0% with placebo, P = .36 by chi-square test).
  
  
  CONCLUSIONS
  Administering prophylactic nebulized hypertonic saline to mechanically ventilated children did not improve clinically relevant outcomes, including duration of mechanical ventilation. Wheezing after hypertonic saline treatment was rare.
authors.affiliation: Division of Critical Care Medicine, Rainbow Babies and Children's Hospital, and the Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio. steven.shein@uhhospitals.org.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Shein
authors.affiliation: Division of Respiratory Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: John T
authors.initials: JT
authors.lastname: Gallagher
authors.affiliation: Division of Respiratory Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Deakins
authors.affiliation: Division of Radiology, Rainbow Babies and Children's Hospital, and the Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Dayna M
authors.initials: DM
authors.lastname: Weinert
mesh_terms: D004311:Double-Blind Method; D005100:Expectorants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D010865:Pilot Projects; D012120:Respiration Disorders / Q000628:therapy*; D012121:Respiration, Artificial; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012122:Ventilators, Mechanical
chemical_list: D005100:Expectorants; D012462:Saline Solution, Hypertonic
keywords: hypertonic saline; mechanical ventilation; pediatric