Role of Nebulized Epinephrine Versus Nebulized Hypertonic Saline in Moderate Bronchiolitis

Shiza Safdar; Sohail Ashraf; Shameen Safdar; Yumna Zafar; Ayesha Naseem; Hafiz Aaqib Mehboob

doi:10.70749/ijbr.v3i2.646

Authors

Shiza Safdar POF Hospital, Wah Cantt, Punjab, Pakistan.
Sohail Ashraf POF Hospital, Wah Cantt, Punjab, Pakistan.
Shameen Safdar POF Hospital, Wah Cantt, Punjab, Pakistan.
Yumna Zafar POF Hospital, Wah Cantt, Punjab, Pakistan.
Ayesha Naseem POF Hospital, Wah Cantt, Punjab, Pakistan.
Hafiz Aaqib Mehboob POF Hospital, Wah Cantt, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i2.646

Keywords:

Bronchiolitis, Nebulized Epinephrine, Hypertonic Saline

Abstract

Objective: To compare the nebulized epinephrine versus hypertonic saline solution in patients presenting with moderate bronchiolitis in terms of mean length of hospital stay. Study Design: Randomized Controlled Trial. Duration and Place of Study: This study was conducted at the Pediatrics Department of POF Hospital, Wah Cantt, from November 2023 to May 2024. Methodology: A total of 144 patients aged 1 day to 24 months with moderate bronchiolitis were randomized into two groups: Group I (nebulized racemic epinephrine) and Group II (3% hypertonic saline). Group I received 0.2 mL racemic epinephrine (USP 2.25%) diluted with 1.8 mL distilled water every 6 hours, while Group II received 2.0 mL hypertonic saline nebulization every 1–4 hours as needed. Vital signs, oxygen saturation, and adverse events were monitored, and length of hospital stay was documented. Results: Group I had a mean age of 10.06±6.98 months and Group II 12.50±6.97 months. The mean hospital stay was significantly shorter for Group I (3.943±0.14 days) compared to Group II (4.800±0.08 days, p=0.000). Stratification by feeding type revealed consistent trends favoring Group I, with breastfed patients showing stays of 3.956±0.15 days in Group I versus 4.800±0.09 days in Group II (p=0.000). Similarly, bottle-fed and other feeding types followed the same pattern. conclusion: Nebulized epinephrine exhibits greater clinical efficacy in the management of pediatric bronchiolitis, resulting in significantly reduced hospital stays compared to hypertonic saline. These findings provide critical insights into pediatric respiratory care, highlighting the necessity of targeted therapeutic approaches for optimizing patient outcomes.

Downloads

Download data is not yet available.

References

Jartti T, Smits HH, Bønnelykke K, Bircan O, Elenius V, Konradsen JR, et al. Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments. Allergy. 2019;74(1):40-52. https://doi.org/10.1111/all.13624.

Alharbi AS, Al-Hindi MY, Alqwaiee M, Al-Shamrani A, Alharbi S, Yousef A, et al. Saudi initiative of bronchiolitis diagnosis, management, and prevention 2024 updated consensus on the prevention of respiratory syncytial virus. Ann Thorac Med. 2024;19(3):190-200. https://doi.org/10.4103/atm.atm_69_24.

Gatt D, Martin I, AlFouzan R, Moraes TJ. Prevention and treatment strategies for respiratory syncytial virus (RSV). Pathogens. 2023;12(2):154. https://doi.org/10.3390/pathogens12020154.

Pereira RA, Oliveira de Almeida V, Zambrano M, Zhang L, Amantéa SL. Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: a systematic review and meta-analysis. Health Sci Rep. 2022;5(3):e598. https://doi.org/10.1002/hsr2.598.

Deeney BT, Cao G, Orfanos S, Lee J, Kan M, Himes BE, et al. Epinephrine evokes shortening of human airway smooth muscle cells following β2 adrenergic receptor desensitization. Am J Physiol Lung Cell Mol Physiol. 2022;323(2):L142-L151. https://doi.org/10.1152/ajplung.00444.2021.

Cahill AA, Cohen J. Improving evidence based bronchiolitis care. Clin Pediatr Emerg Med. 2018;19(1):33-9. https://doi.org/10.1016/j.cpem.2018.02.003.

Baron J, El-Chaar G. Hypertonic saline for the treatment of bronchiolitis in infants and young children: a critical review of the literature. J Pediatr Pharmacol Ther. 2016;21(1):7-26. https://doi.org/10.5863/1551-6776-21.1.7.

Máiz Carro L, Martínez-García MA. Nebulized hypertonic saline in noncystic fibrosis bronchiectasis: a comprehensive review. Ther Adv Respir Dis. 2019;13:1753466619866102. https://doi.org/10.1177/1753466619866102.

Liu L, Pan M, Li Y, Tan G, Yang Y. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020;86(5):639-46. https://doi.org/10.1016/j.bjorl.2020.03.008.

Flores-González JC, Matamala-Morillo MA, Rodríguez-Campoy P, Pérez-Guerrero JJ, Serrano-Moyano B, Comino-Vazquez P, et al. Epinephrine improves the efficacy of nebulized hypertonic saline in moderate bronchiolitis: a randomised clinical trial. PLoS One. 2015;10(11):e0142847. https://doi.org/10.1371/journal.pone.0142847.

Yasin F, Afridi ZS, Mahmood Q, Khan AA, Condon S, Khan RA. Role of nebulized epinephrine in moderate bronchiolitis: a quasi-randomized trial. Ir J Med Sci. 2021;190(1):239-42. https://doi.org/10.1007/s11845-020-02293-5.

Ring J, Klimek L, Worm M. Adrenaline in the acute treatment of anaphylaxis. Dtsch Arztebl Int. 2018;115(31-32):528-34. https://doi.org/10.3238/arztebl.2018.0528.

Abid U, Afzal A, Zaman N. Comparing treatment with nebulized 3% hypertonic saline versus nebulized 0.9% saline in patients with acute bronchiolitis: a double-blind randomized controlled trial. JRMC. 2024 Mar;28(1):440-4. https://doi.org/10.37939/jrmc.v28i1.2335.

Islam KT, Mollah AH, Matin A, Begum M. Comparative efficacy of nebulized 3% hypertonic saline versus 0.9% normal saline in children with acute bronchiolitis. Bangladesh J Child Health. 2018;42(2):130-7. https://doi.org/10.3329/bjch.v42i3.39264

Grewal S, Ali S, McConnell DW, Vandermeer B, Klassen TP. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med. 2009;163(11):1007-12. https://doi.org/10.1001/archpediatrics.2009.196.