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Eur Respir J. 2014 Oct;44(4):913-21. doi: 10.1183/09031936.00159613. Epub 2014 Jun 25.

The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial.

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Dept of Paediatrics, VieCuri Medical Centre, Venlo, The Netherlands.
Dept of Paediatrics, Amphia Hospital, Breda, The Netherlands.
Dept of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands.
Dept of Paediatrics, Elisabeth Hospital, Tilburg, The Netherlands.
Dept of Paediatrics, Catharina Hospital Eindhoven, The Netherlands.
Dept of Paediatrics, Máxima Medical Centre, Veldhoven, The Netherlands.
Dept of Paediatrics, Rijnstate Hospital, Arnhem, The Netherlands.
Dept of Paediatrics, Twee Steden Hospital, Tilburg, The Netherlands.
Dept of Paediatrics, Orbis Medical Centre, Sittard, The Netherlands.
Dept of Paediatrics, Laurentius Hospital, Roermond, The Netherlands.
Dept of Paediatrics, Elkerliek Hospital, Helmond, The Netherlands.
Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.
Dept of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.
Dept of Paediatrics, VieCuri Medical Centre, Venlo, The Netherlands


Bronchiolitis is a common disorder in young children that often results in hospitalisation. Except for a possible effect of nebulised hypertonic saline (sodium chloride), no evidence-based therapy is available. This study investigated the efficacy of nebulised 3% and 6% hypertonic saline compared with 0.9% hypertonic saline in children hospitalised with viral bronchiolitis. In this multicentre, double-blind, randomised, controlled trial, children hospitalised with acute viral bronchiolitis were randomised to receive either nebulised 3%, 6% hypertonic saline or 0.9% normal saline during their entire hospital stay. Salbutamol was added to counteract possible bronchial constriction. The primary endpoint was the length of hospital stay. Secondary outcomes were need for supplemental oxygen and tube feeding. From the 292 children included in the study (median age 3.4 months), 247 completed the study. The median length of hospital stay did not differ between the groups: 69 h (interquartile range 57), 70 h (IQR 69) and 53 h (IQR 52), for 3% (n=84) and 6% (n=83) hypertonic saline and 0.9% (n=80) normal saline, respectively, (p=0.29). The need for supplemental oxygen or tube feeding did not differ significantly. Adverse effects were similar in the three groups. Nebulisation with hypertonic saline (3% or 6% sodium chloride) although safe, did not reduce the length of stay in hospital, duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis.

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