Chest
Volume 123, Issue 2, February 2003, Pages 481-487
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Clinical Investigations
AIRWAYS
Nebulized 3% Hypertonic Saline Solution Treatment in Hospitalized Infants With Viral Bronchiolitis*

https://doi.org/10.1378/chest.123.2.481Get rights and content

Objective:

To determine the utility of inhaled hypertonic saline solution to treat infants hospitalized with viral bronchiolitis.

Design:

Randomized, double-blind, controlled trial. Fifty-two hospitalized infants (mean ± SD age, 2.9 ± 2.1 months) with viral bronchiolitis received either inhalation of epinephrine, 1.5 mg, in 4 mL of 0.9% saline solution (group 1; n = 25) or inhalation of epinephrine, 1.5 mg, in 4 mL of 3% saline solution (group 2; n = 27). This therapy was repeated three times every hospitalization day until discharge.

Results:

The percentage improvement in the clinical severity scores after inhalation therapy was not significant in group 1 on the first, second, and third days after hospital admission (3.5%, 2%, and 4%, respectively). In group 2, significant improvement was observed on these days (7.3%, 8.9%, and 10%, respectively; p < 0.001). Also, the improvement in clinical severity scores differed significantly on each of these days between the two groups. Using 3% saline solution decreased the hospitalization stay by 25%: from 4 ± 1.9 days in group 1 to 3 ± 1.2 days in group 2 (p < 0.05).

Conclusions:

We conclude that in nonasthmatic, nonseverely ill infants hospitalized with viral bronchiolitis, aerosolized 3% saline solution/1.5 mg epinephrine decreases symptoms and length of hospitalization as compared to 0.9% saline solution/1.5 mg epinephrine.

Section snippets

Devices

We utilized a nebulizer (Aeromist Nebulizer Set 61400; B&F Medical by Allied; Toledo, OH) routinely available in our ward connected to a source of pressurized oxygen, from the wall, set to a flow rate of 5 L/min. This device has an output of 3 mL in 6 min, an aerodynamic diameter mass medium of 0.5- to 4-μm range, and a geometric SD of 96% of all liquid nebulized. The nebulizers were administered until empty.

Study Design

This was a randomized, double-blind, controlled trial. Signed informed consent was

Results

Fifty-three previously healthy infants with viral bronchiolitis were enrolled in the study between December 2000 and March 2001. Their mean age was 2.9 ± 2.1 months (range, 0.5 to 12 months). One patient from group 1 was excluded from the analysis because of deterioration immediately after the first treatment inhalation, which required mechanical ventilation; this deterioration was attributed to inhalation of epinephrine. Of the 52 infants who took part in the study analysis, 25 infants were

Discussion

Our study indicates that by substituting normal saline solution with hypertonic saline in the inhalation mixture for delivering epinephrine to hospitalized infants with viral bronchiolitis, the in-hospital stay was reduced by 25%, from 4 days in the 0.9% saline solution group (group 1) to 3 days in the 3% saline solution group (group 2). This possible effect could bear an important economic and clinical impact worldwide; in the United States, > 100,000 children are hospitalized annually at a

Conclusion

On the basis of a faster rate of discharge from the hospital and a significant posttreatment improvement in clinical severity score, we conclude that 3% saline solution/1.5 mg epinephrine is more effective than normal saline solution/epinephrine in a nonseverely ill infant population hospitalized with acute bronchiolitis. Additionally, there was no difference in safety profile.

ACKNOWLEDGMENT

Mona Boaz, MSc, biostatistician of the Edith Wolfson Medical Center, Holon, advised on statistics.

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