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Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial
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  • Published on: 19 November 2019
    Letter to Editor Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial. Raphaelle Jaquet-Pilloud, Marie-Elise Verga, Michel Russo, Mario Gehri, Jean-Yves Pauchard
    • Muthukumar Sakthivel, Attending Physician, Pediatric Emergency Department Sidra Medicine, Qatar
    • Other Contributors:
      • Dure Yasrab, Resident, Pediatrics
      • Kevin Enright, Attending Physician, Pediatric Emergency Department
      • Colin VE Powell, Professor, Senior Attending Physician, Pediatric Emergency Department

    Dear Editor

    We enjoyed reading the study by Jaquet-Pilloud et al. 1 examining the role of nebulised 3% hypertonic saline (HS) and bronchiolitis. We thank the authors for this excellent pragmatic non-blinded, randomised controlled trial. Their conclusions support the UK evidence from the SABRE study 2 and their systematic review3 which provides evidence of the futility of adding hypertonic saline to the management of bronchiolitis when compared to standard care alone with length of stay (LOS) or ready for discharge as the primary outcome. The article was well written and easy to follow. The study examined 121 infants with bronchiolitis recruited over three years from one tertiary centre in Switzerland. We felt it illustrated the very important problem of underpowered studies concluding no differences between two treatment regimens. The authors used the Korppi et al 3 study to assume that the mean LOS for infants admitted to hospital with bronchiolitis was 5 days [120 hours] with a standard deviation of 1.2 days [28.8 hours]. Reduction in hospital stay by 1 day was considered clinically significant and based on this a minimum sample size of 120 (with 60 in each group) was arrived. However the data from this paper by Jaquet-Pilloud et al show that the mean LOS was 47 hours (± 8.5) for nebulised hypertonic saline group and 50.4 hours (±11) for standard care group. The LOS at the authors’ hospital was less than half of the assumption used for their power calculation....

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    Conflict of Interest:
    None declared.