| Objective:Our main aim of this study is to determine the improvement of patient’s condition by comparing the length of hospital stay and improvement in clinical severity score(CS score) in infants with moderate bronchiolitis nebulized with 3% hypertonic saline or 0.9% saline. Background:Bronchiolitis is the most common lower respiratory infectious disease in infants presenting with cough and/or wheeze and occurs most frequently in the winter months. The majority of infants cared for by primary care, a significant number managed by secondary care and a small number by tertiary care. Bronchiolitis typically caused by a viral infection. With improvement in diagnostic ability to identify viruses in respiratory secretions(nasopharyngeal aspirates), multiple viral agents been identified as causative agents of acute bronchiolitis: Respiratory syncytial virus(RSV), Rhinovirus, Parainfluenza viruses, Influenza virus, Adenovirus, and Coronavirus. Bronchiolitis characterized by obstruction and collapse of the small airways during expiration. Airway narrowing, likely caused by virus-induced necrosis of the bronchiolar epithelium, hypersecretion of mucus and round cell infiltration and edema of surrounding submucosa. These changes result in formation of mucus plugs obstructing bronchioles, with consequent hyperinflation or collapse of the distal lung tissue. The diagnosis of bronchiolitis based on clinical presentation, the patient’s age, seasonal occurrence, and findings from physical examination. Because no definitive treatment exists for the specific viruses, therapy mainly directed towards supportive one, including managing the symptoms and making the patient comfortable and not letting to progress in severe stage. Treatment of bronchiolitis by means of nebulization with inhaled corticosteroids and bronchodilator such as salbutamol or ipratropium bromide considered an effective method. Usually, 0.9% normal saline used together with the medications mentioned above. However, there are studies showing that 3% hypertonic saline might be a better choice compared with the normal saline. Hypertonic saline solution, acts by absorbing water from the submucosa, might decrease airway edema and improves mucociliary function by accelerating mucus transport rates. Methods:We analyzed 125 patients undergoing moderate bronchiolitis(with a CS score between 6 and 9) who admitted in pediatric pulmonary department of the first hospital of Jilin University from 1st December 2014 to December 2015. Patients, arranged randomly to nebulize either 3% hypertonic saline with salbutamol plus budesonide(Group 1) or 0.9% saline with salbutamol plus budesonide(Group 2) three times per day until conditions were stable enough for discharge(with a CS score below 3). We recorded the SC scores of each patient before and after the first nebulization every day. There were no differences on color, smell, and other physical properties of the solutions between the two groups. We used a nebulizer(PARI Vios compressor with PARI LC PLUS nebulizer) with tightly fitting facemask providing an efficient delivery of aerosol with a mass median aerodynamic diameter of 0.5 to 5--μm range. Monitoring parameters for improvement or worsening recorded according to CS scores.Outcomes, considered mainly as(1)differences in the length of hospital stay from admission to time taken to reach CS score < 3;(2)the change in CS score after the first nebulization every day. Other minor outcomes include respiratory rate, heart rate, saturation and none add-on treatments. Each variable visually scanned of their histograms, normal Q-Q plots for normalcy of distribution. Categorical data compared using the chisquare test and all continuous variables compared using the pair or unpaired t-test as appropriate. A P value <0.05 was considered statistically significant. Results:125 previously healthy infants, enrolled in the study from 1st December 2014 to December 2015. 124 patients of them completed the study, except only one patient in Group 2 was excluded for the reason of discharging before CS score below 3. Their mean age was 6.92±0.24 months(range, 3 to 12 months). The cases were diagnosed as moderate bronchiolitis with CS scores varying from 6 to 9. The mean length of hospital stay from admission to time taken to reach CS score < 3 was 4.83±0.077 days for the whole subjects investigated, and it differed significantly between the two groups: 4.27±0.90 days in Group 1 and 5.39±0.610 days in Group 2. On the first day of treatment, the mean CS scores at baseline were 7.34±0.1 and 7.39±0.99 for Group 1 and Group 2, respectively. After the first nebulization, the CS scores decreased to 5.94±0.89(SD-0.698) and 6.50±0.094(SD 0.741) of Group 1 and Group 2, respectively. The P value in both groups were less than 0.001, indicating statistically differences between CS scores before and after nebulization by both groups of solutions in the treatment of moderate bronchiolitis. However, the differences of the mean values and standard deviation(SD) results after nebulization in the two groups suggested a better treatment outcome of 3% hypertonic saline with salbutamol plus budesonide than 0.9% normal saline. There were no significant differences between the respiratory rate, heart rate, saturation and add-on therapy in the two groups. No adverse events noted in both groups. Conclusion:As a result, the curative effect of 3% hypertonic saline group was significant better in comparison with the 0.9% normal saline group in terms of the improvement of CS score and length of hospital stay. In conclusion, 3% hypertonic saline is safe and effective in infants with moderate bronchiolitis. |
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