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Systematic review with meta analysis
Nebulised hypertonic saline may be less effective than previously reported in reducing hospital length of stay and admission rate in acute bronchiolitis
  1. Kevin M Overmann1,
  2. Todd A Florin1,2
  1. 1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  1. Correspondence to : Dr Todd A Florin, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, ML 2008, Cincinnati, OH 45229, USA; Todd.Florin{at}

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Acute bronchiolitis is the most common cause of hospitalisation of infants. There is no specific therapy that provides consistent benefit. Nebulised hypertonic saline (HS) may be theoretically effective by improving mucociliary clearance, and reducing airway oedema and mucus viscosity. HS has been investigated as a therapeutic intervention in multiple studies, with inconsistent results. A 2013 Cochrane meta-analysis concluded that HS is a safe and effective treatment for acute bronchiolitis.1 This analysis of 11 randomised controlled trials (RCTs) (1090 infants) found a 1.15 days (95% CI 0.82 to 1.49) shorter mean hospital length of stay (LOS) in those treated with HS compared with normal saline (NS). Although initially promising, subsequent RCTs have shown that HS may not be as effective as …

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  • Contributors TAF and KMO contributed equally to the drafting, critical revision and approval of the submitted manuscript. TAF served as supervising and corresponding author.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.