Prophylactic Use of Nebulized Hypertonic Saline in Mechanically Ventilated Children: A Randomized Blinded Pilot Study.

BACKGROUND: Mucolytic agents, such as nebulized hypertonic saline, may improve airway clearance and shorten the duration of mechanical ventilation, but prospective blinded studies in children undergoing mechanical ventilation are lacking. METHODS: Children <18 y old who had been intubated for <12 h and had an expected duration of mechanical ventilation of >48 additional h were prophylactically given 3 mL of either nebulized hypertonic saline or placebo (0.9% saline) 4 times/d. The primary outcome was duration of mechanical ventilation. Ventilator parameters and the presence of wheezing were recorded before and after study drug administration. RESULTS: The duration of mechanical ventilation was significantly longer in children treated with hypertonic saline (208.1 [interquartile range 136.3-319.8] h) versus those treated with placebo (129.5 [interquartile range 74.4-146.1] h) (P = .03 by Wilcoxon rank-sum test). After adjusting for baseline levels of PEEP, the duration of mechanical ventilation did not differ between groups. Mechanical ventilation parameters, including dead space and dynamic compliance, did not differ between measurements taken before study drug administration versus measurements taken after. New onset wheezing following study drug administration was rare (1.0% with hypertonic saline vs 3.0% with placebo, P = .36 by chi-square test). CONCLUSIONS: Administering prophylactic nebulized hypertonic saline to mechanically ventilated children did not improve clinically relevant outcomes, including duration of mechanical ventilation. Wheezing after hypertonic saline treatment was rare.

Year in review 2014: asthma.

Asthma continues to be recognized as a well-known respiratory disease requiring complex management. Asthma is assessed and treated by clinicians across the continuum. The interest in evidence-based recommendations for diagnosis, treatment, and long-term management is ongoing and essential for aligning clinical practice with its changes. The purpose of this review is to provide updates from recent literature on asthma for clinicians.

Bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease that results from complications related to the lung injury during the treatment of respiratory distress syndrome, or develops in older infants when abnormal lung growth occurs. The definition and classification of BPD have changed since the original diagnosis was established many years ago. The incidence of BPD continues to grow as lower-birth-weight infants continue to survive. The primary focus of all treatment associated with premature infants is on prevention of BPD. Surfactant replacement, invasive and noninvasive ventilation techniques, management of the patent ductus arteriosus, cautious management of oxygen therapy, caffeine, inhaled nitric oxide, and changes in delivery room practices have been studied to assess their effects on the development of the disease. Other strategies used to reduce the long-term effects of this chronic lung disease include bronchodilators, inhaled and systemic steroids, nutrition management, and selected ventilator strategies. The prevention of BPD is targeted at minimizing effects of this pulmonary disease and preventing the long-term sequelae associated with its treatment.