Inhaled Hypertonic Saline Use in the Emergency Department to Treat Acute Viral Bronchiolitis
Inhaled Hypertonic Saline Use in the Emergency Department to Treat Acute Viral Bronchiolitis
Acute viral bronchiolitis is an extremely common childhood disease, responsible for
 approximately 17% of childhood admissions to hospital per year, with an annually cost that
 reaches U$ 500 million.

 Despite being a well known disease among pediatricians, there are few, if any, effective
 treatment options apart from oxygen supplementation and adequate hydration.

 The purpose of this study is to determine wether nebulized hypertonic saline (3%) is more
 effective than normal saline (0,9%) when used in repeated doses during the first 24 hours of
 in-hospital treatment.
Acute viral bronchiolitis is a lower airway infection, caused manly by Respiratory Syncytial
 Virus. Near 1% of children up to 2 years of age get it with sufficient severity to warrant
 hospital admission, with an annual cost of about U$ 500 million in the US, superior, for
 instance, than cystic fibrosis annual cost.

 Despite the physiopathology and clinical course being well known among pediatricians, few
 therapeutical options other than adequate hydration and oxygen supplementation have proven to
 be effective Corticosteroids are not effective and bronchodilators are controversial, and
 treatment is still mostly empiric and lacking evidence.

 In the last few years, there has been a growing interest in the use of nebulized hypertonic
 saline (HS) as a promising approach. The rational is that HS would help reducing edema and
 mucus viscosity, enhancing its rheologic properties. Recent studies suggest that HS could
 reduce up to 1 day (25%) of time until discharge in admitted patients. In the Emergency
 Department, HS was not superior to other forms of treatment, but these studies lack power and
 similarities to draw further conclusions. Also, time of treatment and ideal interval between
 doses are not known as yet.

 To our knowledge, few if any studies have assessed patients with an intermediary (up to 24h)
 time of stay, namely a short stay ward attached to an emergency department. Thus, we have
 endeavoured to determine if repeated doses of nebulized HS are superior to nebulized normal
 saline (NS) during the first 24 hour of treatment, when considered: rate of admission, time
 until discharge, time until attain discharge criteria, and rate of readmission after
 discharge.

 Furthermore, most studies use HS associated to a bronchodilator, because of a theoretical
 possibility that HS alone could induce bronchoconstriction and worsen respiratory symptoms.
 However, recent studies have shown that HS use without bronchodilators have not caused any
 worsening of symptoms in bronchiolitis patients. Therefore, we propose to study the effect of
 HS alone, without the adding of bronchodilators, which would minimize bias in the treatment
 group.
Inclusion Criteria:

 -  Age < 12 months

 -  Clinical diagnosis of bronchiolitis (viral respiratory disease and wheezing)

 -  First episode of wheezing in life

 -  Moderate respiratory distress, defined as 2 of the following: Sat <93%, respiratory
 rate >60 and/or RDAI score >4

 Exclusion Criteria:

 -  Previous episodes of wheezing in history

 -  Use of bronchodilators, corticosteroids or antibiotics in the 24 hours prior to
 admission or at any time during treatment.

 -  Other clinical conditions such as: prematurity, bronchopulmonary dysplasia, cystic
 fibrosis, cardiac disease or immunodeficiencies.

 -  detection of alveolar infiltrates suggestive of pneumonia in radiologic examination

 -  respiratory impairment requiring mechanical ventilation on arrival to hospital.