Despite the fact that clinical guidelines do not recommend the practice, hypertonic saline is still being used in many places.
Hypertonic saline (HS) and its value in treating pediatric patients with bronchiolitis has been a topic of discussion on the AARC Specialty Section discussion lists. Despite the fact that clinical guidelines do not recommend the practice, it is still being used in many places.
Now researchers from Dartmouth-Hitchcock Medical Center in Lebanon, NH, weigh in on the topic in a study published online in JAMA Pediatrics.
Their conclusion: data do not support the use of HS to decrease length of stay (LOS) in infants hospitalized with the condition.
The research involved a reanalysis of cohorts in two previously published meta-analyses that found nebulized HS shortened LOS for bronchiolitis patients. The authors also conducted a search of the literature through September of 2015. Eighteen studies involving 2063 infants with a mean age of 4.2 months and a mean hospital stay of 3.6 days were included.
The researchers found two sources of heterogeneity – defined as a statistical measure of the observed variability between study results specifically intended to measure the likelihood that the variability is due to something more than chance — that they believe call the previous results into question. In the first case, one study population was found to have a widely divergent definition of the primary outcome. A baseline imbalance in mean day of illness at presentation between treatment groups accounted for the second source.
When the investigators controlled for either of these two factors, the heterogeneity was resolved and no effect of hypertonic saline on LOS was noted.
“The appearance of a meaningful summary treatment effect on LOS in the cohort of studies on HS in acute viral bronchiolitis is a result of inappropriately combining studies with meaningful differences in outcome definitions and previously unnoticed systematic bias in treatment group allocation,” conclude the authors. “Hypertonic saline cannot be expected to shorten LOS in bronchiolitis in typical U.S. hospital settings.”