Research Article - Current Pediatric Research (2021) Volume 25, Issue 11
Application of nebulized 3% hypertonic saline in comparison to conventional therapy for treatment of bronchiolitis and effective on hospital duration of patient.
- Corresponding Author:
- Sabah Hassan Alatwani
Department of Pediatric
College of Medicine
University of Karbala
Accepted date: 23rd November, 2021
Objective: To evaluate the using of nebulized 3% hypertonic saline as a treatment to hospitalized infants with bronchiolitis in Karbala providence. Methods: A total of 161 patients (age mean, 6.29 months) with bronchiolitis were studied. Patients (83) were randomized to receive, repeated doses (4 times/day) of nebulized 3% hypertonic saline and a control group (78) treated with conventional therapy. Staying period at hospital is the principle measuring of the results. Results: LOS of 3.38 days was determined in patient group, while 4.67 days in the control group with reduction of 27.8% (P=0.001). Treatment with hypertonic saline was sufficiently tolerated with no adverse effects. Conclusions: application of nebulized 3% hypertonic saline is an effective with low cost for patients hospitalized with moderately severe bronchiolitis.
Conventional therapy, Hospital, Bronchiolitis, Etiology.
Bronchiolitis is one of common Lower Respiratory Tract Infection (LRTI) leading to hospital long stay of infants and children at age of two years or less. It indicates to respiratory infection with episode of wheezing in a child at 12-24 months and it mostly caused by viral infection with pneumonia or atrophy . Most bronchiolitis cases in healthy infants and young children are self-limited. Supportive measures is the therapy in most cases to ensure that the patient get enough oxygen level with hydration . Many factors are important to be considered in management of disease such as age of children, infection stage at time of supportive care, disease severity, primary diagnoses, and etiology type and infection site. At the beginning of the disease course, pharmacotherapy can reverse the obstruction and inflammatory status while alteration of this course may have no benefit in the progress stage of the disease than only obstruction [3-7]. The positive action of pharmacotherapy may be unclear due to the present of predisposing asthma or because of low available information about the early signs and symptoms of bronchiolitis in infants [4,8-10].
Airway edema and mucus plugging can theoretically be reduced by hypertonic saline which also has reduction effect on the persistence pathologic features of acute bronchiolitis . A significant of therapy with nebulized bronchodilator containing of hypertonic saline (3% or 5%) has been indicated by several trials compared with normal saline (0.9%) for hospitalized children with acute bronchiolitis [12-16]. conflicting results is introduced by studies in the ambulatory and emergency departments [17,18]. Saline or saline solution in medicine is usually referred to a sterile liquid of sodium chloride (NaCl) that can be parenterally used .
Concentrations of saline solution are ranging from low, normal to high. Higher concentrations of saline are less common applied in medicine, while it is more used in molecular biology. Normal concentration of Saline (NS) is frequently containing 0.90% of NaCl. Physiological saline or isotonic saline is less commonly used due to technically accurate. The normal saline is commonly used as intravenous solution for patients have a problem to take medicine orally or suffering from dehydration or hypovolemia . The suitable levels of normal saline mainly depends on the patients needs as with persistence diarrhea or with heart failure and its level for adults is typically ranging from 1.5-3 liters per day.
Saline solution is also used for washing of nasal cavity to relieve some common cold symptoms . Such a solution plays a softening and loosing role to clean up the nasal passage for infants and adults. Thus, normal saline can be made at home by dissolving about an amount of half teaspoon of common table salt in a glass of clean tap water. A sterile tap water should be used for saline solution preparation due to prevent entering of contaminated organism such as Amoeba naegleria fowlerii into the nose . Saline solution can be prepared as hypertonic solution at concentration 3% which uses in critical care setting through increased intracranial pressure, or severe hyponatremia . Hypertonic solution also can use as inhalator to help curing of other respiratory problems such as bronchiotitis . It currently suggested using as a first choice for treatment of a cystic fibrosis by the cystic fibrosis foundation.
Treatment by aerosol nebulized hypertonic saline can perform by mechanism depending on disruption the reaction of glycosaminoglycans with IL-8 that reduce inflammation . Hypertonic saline solution has an effect to increase mucociliary clearance of healthy individuals or those with asthma, bronchiectasis, cystic fibrosis, and Sino nasal diseases . It has currently been trialed in acute bronchiolitis patients . A sputum and cough can be induced by hypertonic saline inhalation, which can help to split the sputum from the bronchi and improve the obstruction of airway [23,24]. Thus, theoretical benefits provided by this mechanism may increase the treatment rate of acute bronchiolitis by applying hypertonic saline as nebulizer solution. Nebulizer saline aerosol was synthesized by Fisoneb@ ultrasonic nebulizer (Canadian Medical Products Ltd. Markham, Ontario, Canada) and the saline concentration was increased later to 3, 4, and 5% used as mouthpiece for 7 min with no need to valve or nose clips . To evaluate using of 3% nebulized hypertonic saline for treating moderate or severe infants with bronchiolitis, and it's efficacy in decreasing duration of hospitalization.
The study was conducted in Karbala teaching hospital for children over 15 months from 1st of November 2016 to 30th January 2018. Children admitted for treatment of moderate and severe bronchiolitis up to age 18 months were participated in this study. Disease was diagnosed based on the history of viral infection of upper respiratory parts, and other symptoms such as detection of wheezing or crackles in chest, saturation level of oxygen to less than 94% and detection of significant distress in respiratory as measured by a Respiratory Distress Assessment Instrument (RDAI) at score of more than 4 .
Patients included in the study were divided in to two groups, a study group was treated with 4 ml of 3% HS nebulizer few hours after admission, then every 6 hours, and the control group was treated by the conventional treatment ordered by the attending physician. Inhaled therapies were used by stable condition infant through a tight-fitting facemask, or head box, due to its more suitability to use by them. Clinical response was determined by using RDAI scores (Table 1) and Sa02 level in the beginning of the study and then three times a day. Length of infant stay at the hospital was determined.
Patients with the following findings are excluded from the study:
•History of last episode of wheezing.
•Patient with chronic cardiopulmonary disease or immunodeficiency.
•Critically ill patient at presentation.
•Patient referred to intensive care unit.
The study was approved by informed oral consent obtained from care giver of each patient before enrollment.
Data were analyzed by Excel of Window Microsoft and by the software SPSS version 12.0.1 (SPSS Inc, China) (Table 1).
|Chemical parameter||Score 0||Score 1||Score 2||Score 3|
|Respiratory rate (per minute)||None||40-60||60-70||>70|
|Use of accessory muscles||None||1 accessory muscle used||2 accessory muscle used||>3 accessory muscles used|
|Color/Cyanosis||Pink in room air/no cyanosis||Cyanosed when crying||Pink with oxygen or cyanosed in room air||Cyanosed with oxygen or cardio-respiratory arrest|
|Ausculatory findings||Normal||Decreased air entry, no Rhonchi heard||Decreased air entry, Rhonchi heard||Silent chest|