Studies report contradictory results on use of hypertonic saline to treat adolescent bronchiolitis

Recent data indicates children with bronchiolitis treated with 3% nebulized hypertonic saline showed less improvement than those treated with normal saline; contrary to study findings that show hypertonic saline decreased hospital admissions among children with bronchiolitis.

Todd A. Florin, MD, MSCE, of the Cincinnati Children’s Hospital, and colleagues randomized 62 children, aged 2 to 24 months, who presented to the ED with acute bronchiolitis and continued distress after nasal suctioning and nebulized albuterol sulfate. Thirty-one children received 3% nebulized hypertonic saline and 31 received normal saline.

Todd A. Florin

Children who received hypertonic saline had less improved respiratory assessment change scores (RACS) one hour after treatment, compared with those who received normal saline. When examining individual components of the RACS, researchers found no significant differences in the respiratory distress assessment instrument (RDAI) scores between the two groups. There were no significant differences between individual components of RDAI scores. Children who received normal saline experienced a greater decrease in respiratory rate, with a difference of 8 breaths/minute between baseline and one hour after treatment. There was no significant difference in RACS 2 hours after treatment; however, these results were limited and based on 23 respondents per group.

Susan Wu, MD, of the Children’s Hospital Los Angeles, and colleagues conducted a randomized study in which197 children received normal saline and 211 children received 3% nebulized hypertonic saline after presenting to the ED with viral bronchiolitis. Study participants were younger than 24 months of age and received a mean of 3.36 doses of hypertonic saline or 4.56 doses of normal saline while in the ED.

Susan Wu

Eighty-four children (42.6%) who received normal saline required admission to the hospital compared with 61 (28.9%) who received hypertonic saline. The mean length of stay was 3.92 days for children who received normal saline and 3.16 days for children who received hypertonic saline. Pre-treatment mean RDAI score was 6.16 for the normal saline group and 5.96 for the hypertonic saline group. Post-treatment RDAI scores were 5.32 and 4.88, respectively.

Both studies were conducted in urban settings.

Simon Grewal, MD, of the University of Alberta, Canada, and Terry P. Klassen, MD, of the University of Manitoba, Canada, discussed the contradictory study findings in an accompanying editorial.

“How is it possible for two studies like these to arrive at such differing conclusions? It is possible that chance alone could account for this. There is always some degree of fluctuation in estimates derived from trials, and the smaller studies, the greater will be the fluctuation. As the sample size grows, the estimates became more stable and there is less fluctuation,” they wrote. “Evaluating the efficacy of hypertonic saline in the treatment of bronchiolitis is not an easy task. As seen in these two [trials], as well as in other studies to date, the optimal concentration, dosing frequency, and duration of therapy of hypertonic saline still need to be determined.”

Grewal and Klassen concluded that practitioners should not begin using hypertonic saline in the ED on a routine basis, but that nebulized hypertonic saline may have a role to play for children hospitalized with bronchiolitis.

Disclosure: The researchers reported no relevant financial disclosures.

For more information:

Florin TA. JAMA Pediatr. 2014; doi:10.1001/jamapediatrics.2013.5306.

Wu S. JAMA Pediatr. 2014; doi:10.1001/jamapediatrics.2014.301.