Nebulized hypertonic saline for bronchiolitis in the emergency department: A randomized clinical trial

Todd A. Florin*, Kathy N. Shaw, Marlena Kittick, Stephen Yakscoe, Joseph J. Zorc

*Corresponding author for this work

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

IMPORTANCE: Acute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis. OBJECTIVE: To determine whether nebulized 3%HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with blinding of investigators, health care providers, and parents was conducted at a single urban pediatric ED. The participants included children aged 2 to less than 24 months with their first episode of bronchiolitis and a Respiratory Distress Assessment Instrument score of 4 to 15 after nasal suctioning and a trial of nebulized albuterol. INTERVENTIONS: Patients were randomized to receive either nebulized 3%HS (HS group) or NS (NS group). MAIN OUTCOMES AND MEASURES: The primary outcomewas change in respiratory distress at 1 hour after the intervention, as measured by the Respiratory Assessment Change Score (a decrease indicates improvement). Secondary outcomes included vital signs, oxygen saturation, hospitalization, physician clinical impression, parental assessment, and adverse events. RESULTS The 31 patients enrolled in each treatment arm had similar baseline demographic and clinical characteristics. At 1 hour after the intervention, the HS group demonstrated significantly less improvement in the median Respiratory Assessment Change Score compared with the NS group (HS, -1 [interquartile range, -5 to 1] vs NS, -5 [interquartile range, -6 to -2]; P = .01). There were no significant differences in heart rate, oxygen saturation, hospitalization rate, or other outcomes. There were no adverse events. CONCLUSIONS AND RELEVANCE: Infants with bronchiolitis and persistent respiratory distress after standard treatment in the emergency department had less improvement after receiving 3%HS compared with those who received NS. Based on these results and the existing evidence, administration of a single dose of 3%HS does not appear to be indicated to treat bronchiolitis in the acute care setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01247064.

Original languageEnglish (US)
Pages (from-to)664-670
Number of pages7
JournalJAMA Pediatrics
Volume168
Issue number7
DOIs
StatePublished - Jan 1 2014

Fingerprint

Bronchiolitis
Hospital Emergency Service
Randomized Controlled Trials
Hospitalization
Oxygen
Therapeutics
Vital Signs
Albuterol
Nose
Respiratory Tract Infections
Health Personnel
Heart Rate
Parents
Research Personnel
Demography
Outcome Assessment (Health Care)
Pediatrics
Physicians

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Florin, Todd A. ; Shaw, Kathy N. ; Kittick, Marlena ; Yakscoe, Stephen ; Zorc, Joseph J. / Nebulized hypertonic saline for bronchiolitis in the emergency department : A randomized clinical trial. In: JAMA Pediatrics. 2014 ; Vol. 168, No. 7. pp. 664-670.
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abstract = "IMPORTANCE: Acute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis. OBJECTIVE: To determine whether nebulized 3{\%}HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with blinding of investigators, health care providers, and parents was conducted at a single urban pediatric ED. The participants included children aged 2 to less than 24 months with their first episode of bronchiolitis and a Respiratory Distress Assessment Instrument score of 4 to 15 after nasal suctioning and a trial of nebulized albuterol. INTERVENTIONS: Patients were randomized to receive either nebulized 3{\%}HS (HS group) or NS (NS group). MAIN OUTCOMES AND MEASURES: The primary outcomewas change in respiratory distress at 1 hour after the intervention, as measured by the Respiratory Assessment Change Score (a decrease indicates improvement). Secondary outcomes included vital signs, oxygen saturation, hospitalization, physician clinical impression, parental assessment, and adverse events. RESULTS The 31 patients enrolled in each treatment arm had similar baseline demographic and clinical characteristics. At 1 hour after the intervention, the HS group demonstrated significantly less improvement in the median Respiratory Assessment Change Score compared with the NS group (HS, -1 [interquartile range, -5 to 1] vs NS, -5 [interquartile range, -6 to -2]; P = .01). There were no significant differences in heart rate, oxygen saturation, hospitalization rate, or other outcomes. There were no adverse events. CONCLUSIONS AND RELEVANCE: Infants with bronchiolitis and persistent respiratory distress after standard treatment in the emergency department had less improvement after receiving 3{\%}HS compared with those who received NS. Based on these results and the existing evidence, administration of a single dose of 3{\%}HS does not appear to be indicated to treat bronchiolitis in the acute care setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01247064.",
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Nebulized hypertonic saline for bronchiolitis in the emergency department : A randomized clinical trial. / Florin, Todd A.; Shaw, Kathy N.; Kittick, Marlena; Yakscoe, Stephen; Zorc, Joseph J.

In: JAMA Pediatrics, Vol. 168, No. 7, 01.01.2014, p. 664-670.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nebulized hypertonic saline for bronchiolitis in the emergency department

T2 - A randomized clinical trial

AU - Florin, Todd A.

AU - Shaw, Kathy N.

AU - Kittick, Marlena

AU - Yakscoe, Stephen

AU - Zorc, Joseph J.

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N2 - IMPORTANCE: Acute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis. OBJECTIVE: To determine whether nebulized 3%HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with blinding of investigators, health care providers, and parents was conducted at a single urban pediatric ED. The participants included children aged 2 to less than 24 months with their first episode of bronchiolitis and a Respiratory Distress Assessment Instrument score of 4 to 15 after nasal suctioning and a trial of nebulized albuterol. INTERVENTIONS: Patients were randomized to receive either nebulized 3%HS (HS group) or NS (NS group). MAIN OUTCOMES AND MEASURES: The primary outcomewas change in respiratory distress at 1 hour after the intervention, as measured by the Respiratory Assessment Change Score (a decrease indicates improvement). Secondary outcomes included vital signs, oxygen saturation, hospitalization, physician clinical impression, parental assessment, and adverse events. RESULTS The 31 patients enrolled in each treatment arm had similar baseline demographic and clinical characteristics. At 1 hour after the intervention, the HS group demonstrated significantly less improvement in the median Respiratory Assessment Change Score compared with the NS group (HS, -1 [interquartile range, -5 to 1] vs NS, -5 [interquartile range, -6 to -2]; P = .01). There were no significant differences in heart rate, oxygen saturation, hospitalization rate, or other outcomes. There were no adverse events. CONCLUSIONS AND RELEVANCE: Infants with bronchiolitis and persistent respiratory distress after standard treatment in the emergency department had less improvement after receiving 3%HS compared with those who received NS. Based on these results and the existing evidence, administration of a single dose of 3%HS does not appear to be indicated to treat bronchiolitis in the acute care setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01247064.

AB - IMPORTANCE: Acute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis. OBJECTIVE: To determine whether nebulized 3%HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial with blinding of investigators, health care providers, and parents was conducted at a single urban pediatric ED. The participants included children aged 2 to less than 24 months with their first episode of bronchiolitis and a Respiratory Distress Assessment Instrument score of 4 to 15 after nasal suctioning and a trial of nebulized albuterol. INTERVENTIONS: Patients were randomized to receive either nebulized 3%HS (HS group) or NS (NS group). MAIN OUTCOMES AND MEASURES: The primary outcomewas change in respiratory distress at 1 hour after the intervention, as measured by the Respiratory Assessment Change Score (a decrease indicates improvement). Secondary outcomes included vital signs, oxygen saturation, hospitalization, physician clinical impression, parental assessment, and adverse events. RESULTS The 31 patients enrolled in each treatment arm had similar baseline demographic and clinical characteristics. At 1 hour after the intervention, the HS group demonstrated significantly less improvement in the median Respiratory Assessment Change Score compared with the NS group (HS, -1 [interquartile range, -5 to 1] vs NS, -5 [interquartile range, -6 to -2]; P = .01). There were no significant differences in heart rate, oxygen saturation, hospitalization rate, or other outcomes. There were no adverse events. CONCLUSIONS AND RELEVANCE: Infants with bronchiolitis and persistent respiratory distress after standard treatment in the emergency department had less improvement after receiving 3%HS compared with those who received NS. Based on these results and the existing evidence, administration of a single dose of 3%HS does not appear to be indicated to treat bronchiolitis in the acute care setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01247064.

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