Postgraduate Program in Health Sciences and Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande-RS, Brazil.
Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil.
Pediatr Pulmonol. 2018 Aug;53(8):1089-1095. doi: 10.1002/ppul.24066. Epub 2018 Jun 12.
This meta-analysis aimed to assess the efficacy of nebulized hypertonic saline (HS) on the rate of hospitalization in infants with acute bronchiolitis in the Emergency Department (ED) setting.
We searched PubMed, Virtual Health Library-BVS and Cochrane CENTRAL from inception until January 31, 2018. We selected randomized trials that compared nebulized HS with normal saline (NS) or standard care in children up to 24 months of age with acute bronchiolitis in the ED setting. We conducted random-effects meta-analyses to estimate the risk ratio (RR) and 95% confidence interval (CI).
A total of 293 records were screened and 8 trials involving 1708 patients were included. The meta-analysis showed a 16% reduction in the risk of hospitalization among patients treated with HS compared to NS (risk ratio [RR]: 0.84, 95% confidence interval [CI]: 0.71-0.98, P = 0.03). A significant effect of HS in reducing the risk of hospitalization was found only in the subgroup analyses of trials in which HS was mixed with bronchodilators, multiple doses (≥3) were given, and risk of bias was low.
Nebulized hypertonic saline may potentially reduce the risk of hospitalization in infants with acute bronchiolitis in the ED setting. Quality of evidence is moderate due to substantial clinical heterogeneity between studies and large multicenter trials are still warranted.
本荟萃分析旨在评估在急诊科（ED）环境中，雾化高渗盐水（HS）对急性细支气管炎婴儿住院率的疗效。
我们检索了 PubMed、Virtual Health Library-BVS 和 Cochrane CENTRAL 从建库到 2018 年 1 月 31 日的数据。我们选择了比较雾化 HS 与生理盐水（NS）或标准治疗在急诊科急性细支气管炎的 24 个月以下儿童的随机试验。我们进行了随机效应荟萃分析，以估计风险比（RR）和 95%置信区间（CI）。
共筛选出 293 条记录，纳入了 8 项涉及 1708 例患者的试验。荟萃分析显示，与 NS 相比，HS 治疗的患者住院风险降低了 16%（RR：0.84，95%CI：0.71-0.98，P=0.03）。仅在 HS 与支气管扩张剂混合、给予多次（≥3 次）以及偏倚风险较低的试验亚组分析中发现 HS 对降低住院风险有显著影响。
在急诊科环境中，雾化高渗盐水可能降低急性细支气管炎婴儿的住院风险。由于研究间存在显著的临床异质性，证据质量为中等，仍需要进行高质量的多中心试验。
