July 2014

The Tale of 2 TrialsDisentangling Contradictory Evidence on Hypertonic Saline for Acute Bronchiolitis

Author Affiliations
  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  • 2Translating Emergency Knowledge for Kids, Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
  • 3Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada

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JAMA Pediatr. 2014;168(7):607-609. doi:10.1001/jamapediatrics.2014.423

For pediatricians looking for answers on how best to provide treatment for their patients, nothing can be more frustrating than 2 randomized clinical trials (RCTs) with contradictory results. It may encourage nihilism and a throwing up of one’s hands, thinking clinical researchers have no idea what they are doing by producing data and gaining publications but not shedding light on the tough management issues that pediatricians face day to day. These 2 RCTs1,2 on the use of nebulized hypertonic saline for the management of bronchiolitis could potentially lead practitioners to despair in this way. One RCT1 indicates that hypertonic saline is very helpful, can improve a patient’s condition clinically, and can lead to reduced hospitalizations. The other RCT2 comes to the opposite conclusion. Yet ultimately, pediatricians need some guidance as to what to do with the next patient with bronchiolitis whom they will assess and provide with treatment.

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