KiDrug Alert Journal Club. A Critical Review of: "A Randomized Trial of Nebulized 3% Hypertonic Saline with Epinephrine in the Treatment of Acute Bronchiolitis in the Emergency Department"

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Tania Principi
Luba Komar




Physicians continue to look for an effective treatment to alleviate respiratory distress in infants with acute bronchiolitis. Researchers in Edmonton, Alberta examined the effectiveness of nebulized 3% hypertonic saline with epinephrine compared with nebulized normal saline and epinephrine to improve respiratory distress in the emergency department as measured by the Respiratory Assessment Change Score (RACS) from baseline to 120 minutes. Forty-eight infants 6 weeks to 12 months with a diagnosis of mild to moderate bronchiolitis and oxygen saturations between 85%-96% were enrolled in the study. Patients were excluded if they had any preexisting cardiac or pulmonary disease including asthma, previous bronchodilator use or severe illness requiring resuscitation.

Patients were randomized to receive 0.5ml of 2.25% racemic epinephrine with either 2.5ml of 3% hypertonic saline or 0.9% normal saline. Respiratory rate, oxygen saturation, heart rate and Respiratory Distress Assessment Instrument (RDAI) score were obtained at baseline and every 30 minutes for a total of 120 minutes. Physicians were able to order a second dose of the study medication at their discretion as well as prescribe any additional interventions. No statistically significant difference was noted in the change in RACS and oxygen saturation between the two groups at 120 minutes. The hypertonic saline group had 5 fewer hospital admissions, an absolute difference in admission rate of 22%; however, this did not reach statistical significance.

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