3% Hypertonic saline vs normal saline nebulization in children with acute bronchiolitis. Critical appraisal of an article "Hypertonic (3%) saline vs 0.9% saline nebulization for acute viral bronchiolitis: A randomized controlled trial.

Question: Nebulization with hypertonic saline have been shown to be effective in management of acute bronchiolitis in different studies. In the present study duration of hospital stay and clinical severity scores of children admitted with acute bronchiolitis were compared between two groups. One group received nebulization with 3% hypertonic saline while other group received nebulization with 0.9% normal saline. Methods: This study was a double blinded randomized controlled trial conducted in a tertiary care teaching hospital in Jaipur, India from September 2009 to December 2010. Study population included 250 hospitalized children aged 1-24 months with clinical diagnosis of acute bronchiolitis of moderate severity as assessed by clinical severity score proposed by Wang et al. The study population was randomized into two groups to receive either nebulization of 4 ml of 3% hypertonic saline or 4 ml of 0.9% saline, along with 2.5 mg salbutamol in both groups, at 4 hourly intervals till the patients were fit for discharge. Fitness for discharge was defined by authors as "feeding well, no need of IV fluids and oxygen therapy, clinical severity scores <= 3, absence of accessory muscle use or tachypnoea (respiratory rate < 31 breaths/min) and oxygen saturation > 92% on air". Main results: The results of the study were in three forms viz baseline characteristics, duration of hospital stay and improvement in clinical severity scores between above two groups. Baseline characteristics were similar in both groups. The clinical severity scores were recorded at the time of recruitment and twelve hourly thereafter till discharge. The median clinical severity scores of the two groups were similar at the time of recruitment and thereafter in two groups. The duration of hospital stay was 63.93 +/- 22.43 h in 3% saline group which was similar to 63.51 +/- 21.27 h in 0.9% saline group (P = 0.878). None of parents, caregivers or treating physicians were reported any adverse events in both groups. Conclusion: Nebulization with 0.9% normal saline or 3% hypertonic saline has got similar efficacy in terms of duration of hospital stay and improvement in clinical severity scores among the children admitted with acute bronchiolitis. Copyright (C) 2014, INDIACLEN. Publishing Services by Reed Elsevier India Pvt Ltd. All rights reserved.