Hypertonic Saline for Bronchiolitis in the ED: Studies Give Conflicting Results — Physician’s First Watch
Hypertonic Saline for Bronchiolitis in the ED: Studies Give Conflicting Results
By Amy Orciari Herman
Two studies in JAMA Pediatrics offer conflicting results for using hypertonic saline to treat young children presenting to the emergency department with bronchiolitis. Looking for guidance, editorialists turn to a recent systematic review.
In the first study, some 60 children (aged 2 to less than 24 months) with persistent respiratory distress after albuterol therapy in the ED were randomized to a single dose of 3% hypertonic saline or normal saline. At 1 hour, children who'd received hypertonic saline had less improvement in respiratory distress than those who'd received normal saline.
In the second study, 400 children in the ED were randomized to up to three doses of 3% hypertonic or normal saline. The admission rate was lower in the hypertonic- versus normal-saline group (29% vs. 43%), but there were no differences in length of stay or in a respiratory distress measure.
Editorialists, incorporating these findings with those from a 2013 Cochrane review, conclude: "We would not start using hypertonic saline in the emergency department on a routine basis. However, nebulized hypertonic saline may have a role to play for children hospitalized with bronchiolitis."