Efficacy and safety of nebulized hypertonic saline with or without epinephrine in management of acute bronchiolitis

Abstract

Background: Bronchiolitis is an acute viral infection of the lower respiratory tract in children under two years of age, with peak incidence occurring between 2 and 10 months of age. Objective: To evaluate the efficacy and safety of nebulized hypertonic saline with or without epinephrine in the management of acute bronchiolitis. Materials and Methods: A longitudinal quasi-experimental study was conducted in infants with mild acute bronchiolitis admitted to the Mario Catarino Rivas National Hospital (HNMCR). A total of 26 cases were randomly assigned: 12 received nebulizations with 3% hypertonic saline plus 1 ml of epinephrine (HSS+E), and 14 received 3 ml of 3% hypertonic saline alone (HSS). Treatments were administered every 4 hours. The Wood-Downes-Ferrés Score, oxygen saturation, and post-nebulization complications were assessed every 6 hours over a 24-hour period. The study was approved by an ethics committee. Results: Hospital stay was significantly shorter in the HSS group compared to the HSS+E group (1.79 ± 0.80 days vs. 2.50 ± 0.79 days; p = 0.032). Clinical scores improved in both groups, but the difference was not statistically significant (p = 0.187 vs. p = 0.074, at admission and after 24 hours). Complications were significantly more frequent in the HSS+E group after the first three nebulizations (p = 0.007) and at 12 hours (p = 0.019). Conclusion: Nebulizations with HSS and HSS+E were equally effective; however, HSS alone demonstrated greater safety and significantly reduced hospital stay in infants with mild acute bronchiolitis.