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JOURNAL ANALYSIS
EXPLORING THE EFFECTIVENESS OF USING HYPERTONIC SALINE
FOR THE TREATMENT OF NEBULIZATION IN CHILDREN WITH
BRONCHIOLITIS

Original Title : Exploring the Efficacy of Using Hypertonic Saline for the
Treatment of Nebulization in Children with Bronchiolitis:
Meta-Analysis of a Randomized Controlled Trial

Writer : Chia-Wen Hsieh, Chehfeng Chen, Hui-Chuan Su, and Kee-Hsin Chen

Published : BMC Pediatrics, 2020.two:10.1186/s12887-020-02314-3

Abstract

A. BACKGROUND
1. Journal Selection Background

The author's background in choosing this journal for evaluated the

efficacy and safety of HS in the implementation of treatment with nebulized
HS among children with bronchiolitis.
2. Research Background in journal
Bronchiolitis is the most common lower respiratory tract infection in
infants, affecting 68.8% of infants and neonates <12 months of age, and is the
leading cause of hospitalization in children during the first year of life.
Bronchiolitis is mainly caused by a viral infection that results in inflammation
of the bronchial formations in the lungs. The infection can last 2~3 weeks, and
 causes mucosal congestion and phlegm secretion during the course of the
disease. Common symptoms include excessive coughing with tachypnea,
fever, and whezing. In cases of severe nasal congestion, a child may use open
mouth breathing and is prone to dyspnea caused by tracheal obstruction,
which can lead to respiratory failure in severe cases.

B. AIM
1. Journal Review Purpose
The author's purpose of conducting a journal review is to provide an
outline explanation to the reader without having to read the journal as a whole
and to make it easier for readers to understand the purpose of the researcher
who wants to convey to the reader. And most importantly as a
recommendation for hospitals so that this intervention can be applied.
2. Research Objectives in Journals
In this study, the researcher wants to updated the effectiveness and
safety of using hypertonic saline (3%) for the treatment of nebulization in
children with bronchiolitis, with the aim of providing a reference for clinical
care.

C. METHOD
Meta Analysis and systematically This study screened the following online
databases: Cochrane, PubMed, EMBASE, and the Airiti Library.

D. RESULTS
Results showed no significant difference-improvement of disease for <1
day nebulized treatment; however, with a longer nebulization duration of
treatment with hypertonic saline, the improvement in respiratory distress severity
scores was more significant. We speculate the following two reasons could be the
 cause of this effect. Firstly, it takes more than 1 day for hypertonic saline to reach
its efficacy, after the children were hospitalized for treatment, their autoimmunity
and body strength recovered as the treatment duration increased. Second, the
severity of the disease gradually decreases. liorated along with the course of the
disease, thus showing significantly more treatment efficacy.

E. DISCUSSION
The results of the meta-analysis in this study showed that compared with the
use of normal saline and regardless of whether the children were hospitalized or
not, the use of hypertonic saline for the treatment of nebulization increased the
severity of respiratory distress, prolongs sleep,
reduce the frequency of waking at night, and shorten the LOS of children. For
non-hospitalized children, it also reduces hospitalization rates. All subjects
included in the trial were diagnosed with acute bronchiolitis, and there were no
significant differences in the sex ratio. However, the severity of respiratory
syncytial virus (RSV) infection was inconsistent, and this may have influenced
the effect of the intervention. In addition, all subjects in this study were children
<2 years of age, and only one study included subjects aged between 6 years.
months and 5 years. However, the outcome measure for the severity of respiratory
distress in that case
Certain studies are recorded as medians and quartiles and cannot be included in
the calculation of the data. In the future, the study was excluded from the meta-
analysis. This study included only subjects <2 years of age for analysis; therefore,
additional research will be needed to verify whether the study results are suitable
for children >2 years of age.
There were differences in the intervention measures in each of the included
studies. The nebulization treatment time lasts for 20~30 minutes, but the dose of
salt used for nebulization ranges from 2 to 5ml. In addition, for subjects with
different clinical symptoms, most studies
 combination treatment with epinephrine, bronchodilators, or steroids. Although
this may have affected treatment outcomes, it is a variable that cannot be avoided
because of the need for treatment. Regarding this, the study conducted subgroup
analysis on the above two variables (saline dose and drug combination).

F. JOURNAL ANALYSIS
1. Excess
This journal has advantages regarding how to administer nebulized hypertonic
saline to achieve its efficacy.
2. Deficiency
This journal has flaws i.e. inconsistent disease severity in the included
subjects

G. NURSING IMPLICATIONS
The results of this study can be a reference for hospitals or medical personnel
in providing interventionsandsafety of using hypertonic saline (3%) for nebulized
treatment in children with bronchiolitis,

H. APPLICATION IN HOSPITAL
Givelonger nebulization duration of treatment with hypertonic saline, because
it takes more than 1 day for hypertonic saline to achieve its efficacy.

I. JOURNAL APPLICATION OBSTACLES AND SOLUTIONS

Resistance : The obstacle to this intervention or therapy is that it requires
permission from the hospital before giving the intervention or therapy to the
patient.
Solution : The solution to these obstacles is to ask permission or explain the
benefits of the intervention or therapy that will be given to the patient.
J. CONCLUSION
Using hypertonic saline for the treatment of nebulization in children
Patients with bronchiolitis can significantly improve the correctness of respiratory
distress, shorten LOS, and improve a child's nighttime sleep. It is recommended
that large-scale randomized clinical trials with a standardized design be conducted
in the future to investigate the effect of hypertonic saline in children with
bronchiolitis.

NB: Attach the original journal