Could This Be the Last Word on Hypertonic Saline?

Only a few years ago, hypertonic saline had a reputation as a potentially evidence-based therapy for acute viral bronchiolitis in young children.¹ However, as more trials were published, the evidence seemed to devolve. One assessment of the current state of the evidence on hypertonic saline treatment in bronchiolitis is that it conforms to the pattern described by Ioannidis² in the famous article entitled, “Why Most Published Research Findings Are False.” Ioannidis² and others³ have noted the tendency in medicine for the rapid uptake of new therapies based on positive early studies, which then requires reversal as additional trials inevitably result in regression to the mean. Publication bias—the fact that small positive studies are more likely to be published than small negative studies, which may simply be labeled underpowered and discarded—plays a major role in perpetuating this pattern. With respect to hypertonic saline, it is fair to say that early enthusiasm has evolved into increasing skepticism because of the addition of more recent negative studies and further consideration of significant heterogeneity in the populations under study, particularly in the inpatient literature.^4-6