The use of hypertonic saline remains somewhat controversial because observational studies are conflicting. The need for a well-done randomized controlled trial (RCT) of hypertonic saline to help determine whether or not this therapy makes sense is certainly warranted—and fortunately Silver et al. (doi/10.1542/peds.2015-1037) have opted to share the results of such a trial in an article being released this week in our journal.
The authors prospectively randomized and followed almost 200 infants less than one year old with bronchiolitis who received either 3% hypertonic saline (HS) or normal saline (NS) every four hours as a nebulized solution with the outcome being length of stay as well as adverse events, such as clinical deterioration or readmissions. The results may make a difference in what you opt to use on your patients to loosen their secretions –especially if you were previously using hypertonic saline, given the lack of improvement in patients treated with this solution. Rather than share all the results with you in this blog, I would encourage you to link to the study and see what a difference or lack thereof results when hypertonic saline is compared to normal saline.
The benefits of learning from this RCT will make you and your patients breathe more easily when it comes to perhaps not adding HS to your routine care of the hospitalized infant with bronchiolitis. Simply put, HS might not be the solution to improving bronchiolitis outcomes. Read the study and learn more!