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Randomised controlled trial
The therapeutic value of hypertonic saline in acute bronchiolitis remains unclear
  1. Jay Pershad
  1. Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee, USA
  1. Correspondence to: Professor Jay Pershad, Division of Pediatric Emergency Medicine, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, 50 N Dunlap, St. Memphis, TN 38103, USA; jay.pershad{at}mlh.org

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Commentary on: Wu S, Baker C, Lang ME, et al. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA Pediatr 2014;168:657–63 and Florin TA, Shaw KN, Kittick M, et al. Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial. JAMA Pediatr 2014;168:664–70.

Context

Bronchiolitis is common in children below 2 years of age and is a leading cause of infant hospitalisation, accounting for $1.73 billion in hospital charges in the USA annually.1 The putative effect of hypertonic saline (HTS) in bronchiolitis is to absorb mucosal water, hydrate the airway–surface liquid in the bronchioles and enhance mucociliary clearance.2 However, the therapeutic value of HTS in acute bronchiolitis remains unclear.

Methods

Both randomised controlled trials (RCTs) were conducted in urban, tertiary level, paediatric emergency departments (ED) in the USA. They excluded children with significant comorbidity, and compared the effect of nebulised 3% HTS with normal saline (NS) controls. Both studies used albuterol, given either just prior to or within 90 min of HTS.

Findings

Florin and colleagues enrolled 31 patients in each group, concluding that improvement in Respiratory Assessment Change Score (RACS; primary outcome) 1 h after intervention was less in the HTS group than the NS group (difference in mean RACS=2.5, 95% CI 0.5 to 4.6). A …

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