PURPOSE OF THE STUDY.
To determine the effect of inhalation of hypertonic saline in children presenting to the emergency department (ED) with acute wheezing, on length of stay (LOS), admission rate (AR), and clinical severity score (CS).
Included in the study were 41 children presenting to 1 medical center in Israel.
In a randomized, controlled, double-blinded study, 41 children aged 1 to 6 years old (mean age 31.9 months), presenting to the ED with acute wheezing and a CS ≥6, were randomly assigned to receive nebulized albuterol containing either hypertonic saline 5% (n = 16) or normal saline (n = 25) for the course of their treatment. While in the ED, induced sputum was obtained and tested via polymerase chain reactions for viral respiratory pathogens. Various statistical analyses were used to compare the LOS, AR, and CS between the 2 groups. Of note, patients admitted to the ICU were excluded from the study.
The LOS in the hypertonic saline group was a median of 2 days compared with the normal saline group median of 3 days (P = .027). The AR was 62.2% in the hypertonic saline group versus 92.0% in the normal saline group (P ≤ .05). The CS greatly improved in both groups; however, no significant statistical difference was determined. Of the 29 sputum samples obtained and tested, 83% were positive for ≥1 respiratory virus, with the most common being rhinovirus. No adverse effects were observed in either group.
Administering nebulized hypertonic saline to wheezing children presenting to the ED significantly shortened the LOS and hospital AR, when compared with nebulized normal saline.
Virus-induced wheezing episodes and asthma exacerbations are common in children’s EDs. The rationale for using hypertonic saline was that most acute wheezing episodes in preschool children are associated with rhinovirus, which decreases extracellular adenosine triphosphate levels, leading to airway surface liquid dehydration. This, along with submucosal edema, mucus plaques, and inflammation, causes failure of mucus clearance. Therefore, the authors evaluated this treatment to facilitate mucus clearance and hydration. This simple intervention appears to improve outcomes with minimal or no side effects. However, the small number of participants in this study limits the generalizability of conclusions.
- Copyright © 2013 by the American Academy of Pediatrics