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Use of Nebulized Hypertonic Saline

Bronchiolitis Clinical Pathway Committee recommendation: Based on very low quality evidence, a conditional recommendation is made against use of nebulized 3% hypertonic saline (HS) for routine management of bronchiolitis based on evidence showing the limited benefits of treatment are outweighed by the cost of treatment and burden on hospital staff. Additional considerations should be taken for patients with history of prematurity or comorbidities for whom HS may be of higher value.
 
Literature supporting this recommendation: Eleven randomized control trials showed a shorter length of stay for patients receiving treatment with HS, MD = -6.47 hours, 95% CI [-12.72, -0.22], p = .04. There was no difference in the need for oxygen supplementation, duration of oxygen supplementation, or improvement of clinical severity scores for patients receiving treatment with HS when compared to no treatment with HS. The potential for shorter length of stay was balanced against the associated costs (monetary and otherwise). 
 
Critically Appraised Topic (CAT): Bronchiolitis Hypertonic Saline

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.