ABSTRACT
Background: Acute bronchiolitis is the most common lower respiratory tract infection in young infants and young children. The respiratory syncytial virus is the commonest cause of bronchiolitis. Recently the role of nebulized 3% saline has come into focus. Nebulized adrenaline has also been suggested as another treatment option, its primary role being the reduction of mucosal edema, which is an important part of the disease pathology in bronchiolitis. Objective: To see the effects of nebulized adrenaline in comparison to nebulized 3% hypertonic saline in the treatment of acute bronchiolitis. Material & Methods:This was a randomized controlled trial, carried out in the Department of Pediatrics, Bangladesh Shishu Hospital and Institute from October 2017 to March 2020. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted with acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 3% nebulized hypertonic saline (group A=45) or to the nebulized adrenaline-1:1000 group (group B=45). Monitoring was done by respiratory distress assessment instrument (RDAI) score at 12 hours interval for 1st 24 hours and then 24 hourly till the patient was ready for discharge. The efficacy was determined by assessing clinical severity score/RDAI score and length of hospital stay. Data were analyzed using SPSS version-23.Results:The mean age was found 6.34±3.89 months in group A and 6.06±3.55 months in group B. The majority of patients were males in both groups. All patients had a cough, breathing difficulty, Ronchi, and chest indrawing in both groups. Changes in heart rate were 5.68±6.61/min in group A and 2.86±5.87/min in group B, which was significantly decreasing in group A than in group B. Mean clinical severity scores at 12 hours and at 24 hours were statistically significant (p<0.05). However, mean clinical severity scores at baseline, at 48 hours, at 72 hours, and at 96 hours were not statistically significant. The mean duration of oxygen therapy was found 15.00±5.36 hours in group A and 24.63±11.64 hours in group B. Which indicates that the duration of oxygen therapy was significantly higher in group B than in group A. Majority of the patients of group A and group B were discharged within 72 hours 39(86.7%) and 28(62.2%) respectively, which was statistically significant.Conclusions:Nebulization with 3% hypertonic saline significantly reduced clinical severity score and length of hospital stay in case of acute bronchiolitis in comparison to nebulized adrenaline.
ABSTRACT
Objective To investigate the effects of 3％ and 7.5％ hypertonic saline (HS) on hemorrhagic shock patients in Emergency Department.Methods From December 2008 to February 2012,patients older than 15 years with severe trauma and systolic blood pressure (SBP) ≤70 mmHg or 70 to 90 mmHg with heart rate≥ 108 per minute were divided into three groups randomly (random number).Group A:patients treated with 3％ hypertonic saline (HS) 300 mL + lactated Ringer' s solutions (LRS).Group B:patients treated with 7.5％ HS 300 mL + LRS.Group C:patients treated with LRS.The mean arterial pressure (MAP),blood pressure (BP),heart rate (HR) were recorded before infusion and at 10,30,45,60 minutes successively after infusion.Incidence of complications and mortality rates were compared between groups.Results Atotal of 148 patients were enrolled in this study.Compared with LRS grouop,MAP was restored more promptly and maintained persistently in 3％ HS group and 7.5％ HS group,and the total volume of fluid infused was decreased to almost 50％ of LRS in the first 1 hour.No significant differences in MAP levels were observed between group A and B except 30 minutes after infusion.Single bolus of 7.5％ HS infusion resulted in increased of HR to mean 127 beats per minute at 10 minutesafter fluid resuscitation.Higher incidence of arrhythmia and transient hypotension occurred in 7.5％ HS group.There were no statistical differences of changes of electrolytic indices,mortality rates,incidences of ARDS and MODS among three groups.Conclusions Resuscitation with 3％ HS provide similar benefits and lower risk of complications compared with 7.5％ HS and LRS.This study demonstrates the practicability and safety of 3％ HS for fluid resuscitation of patients with hypovolemic shock.
ABSTRACT
Acute liver failure (ALF) is a clinical condition with high mortality. The most common cause of death in ALF is cerebral edema. We present a 12-year-old boy with hepatitis A-related acute liver failure in grade IV hepatic encephalopathy successfully managed in the ICU using continuous hypertonic saline as the preferred osmotherapy.