Abstract
Bronchiolitis is defined as the first episode of lower respiratory tract infection in patients under 2 years of age. Despite numerous studies, there is still insufficient data to draw firm conclusions regarding its efficacy (or lack thereof). For these reasons, a systematic review was conducted to evaluate the efficacy and safety of 3% nebulized saline solution in patients with acute bronchiolitis. A systematic review was performed following the PRISMA methodology. The search yielded 874 articles; after removing duplicates, screening titles/abstracts for relevance, and assessing content, 10 studies were selected. Several reviewed articles affirmed its effectiveness in reducing symptoms or clinical severity. Analysis of adverse effects confirmed a low occurrence of mild adverse reactions, or even their absence, with no serious adverse effects reported. The reviewed articles reported hospital stays ranging from 3.7 to 4 days and earlier hospital discharges. Despite significantly modifying these variables, it was generally reported that there is insufficient evidence of its effectiveness. It is concluded that it is a safe treatment in pediatric patients with bronchiolitis, associated with minor adverse events, but further studies are needed to confirm its efficacy.
References
Angoulvant, F., Bellêttre, X., Milcent, K., Teglas, J. P., Claudet, I., Le Guen, C. G., De Pontual, L., Minodier. P., Dubos, F., Brouard, J., Soussan-Banini, V., Degas-Bussiere, V., Gatin, A., Schweitzer, C., Epaud, R., Ryckewaert, A., Cros, P., Marot, Y., Flahaut, P., ... & Gajdos, V. (2017). Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA pediatrics, 171(8), e171333. https://pubmed.ncbi.nlm.nih.gov/28586918/
Angurana, S. K., Williams, V., & Takia, L. (2023). Acute viral bronchiolitis: A narrative review. Journal of Pediatric Intensive Care, 12(02), 079-086. https://doi.org/10.1055/s-0040-1715852
Beal, G., Barbier, C., Thoret, S., Rubio, A., Bonnet, M., Mazet, R., Ego, A., & Pin, I. (2019). Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: a blinded non-inferiority randomized controlled trial. BMC pediatrics, 19(417), 1-7. https://doi.org/10.1186/s12887-019-1804-0
Carsin, A., Sauvaget, E., Bresson, V., Retornaz, K., Cabrera, M., Jouve, E., Truillet, R., Bosdure, E., & Dubus, J. C. (2017). Early halt of a randomized controlled study with 3% hypertonic saline in acute bronchiolitis. Respiration, 94(3), 251-257. https://doi.org/10.1159/000477495
Fuentes, C., Cornejo, G., & Bustos, R. (2016). Actualización en el tratamiento de bronquiolitis aguda: menos es más. [PDF] Neumología Pediátrica, 11(2), 65-70. https://www.laboratoriosmar.com.ar/interno/trabajos_cientificos/62_Bronquiolitis_Neumonologia_Pediatrica.pdf
Gill, P. J., Chanchlani, N., & Mahant, S. (2022). Bronchiolitis. CMAJ, 194(6), E216. https://doi.org/10.1503/cmaj.211810
Florin, T. A., Byczkowski, T., Ruddy, R. M., Zorc, J. J., Test, M., & Shah, S. S. (2015). Utilization of nebulized 3% saline in infants hospitalized with bronchiolitis. The Journal of pediatrics, 166(5), 1168–1174 https://doi.org/10.1016/j.jpeds.2015.01.045
Hsieh, C. W., Chen, C., Su, H.-C., & Chen, K.-H. (2020). Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials. BMC Pediatrics, 20(1), 434. https://doi.org/10.1186/s12887-020-02314-3
Palacios Jaimes, M. L., Ocaña Servin, H. L., García Argueta, I., Hernández Sánchez, M., Camacho Beiza, I. R., & Jaimes García, J. (2024). ¿Se deben usar soluciones hipotónicas o hipertónicas en los nebulizadores empleados para enfermedades broncopulmonares en el 2024, cierto o falso?. Revista Científica de Salud y Desarrollo Humano, 5(3), 1294–1308. https://doi.org/10.61368/r.s.d.h.v5i3.333
Jaquet-Pilloud, R., Verga, M. E., Russo, M., Gehri, M., & Pauchard, J. Y. (2019). Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial. Archives of disease in childhood, 105(3), 236-240. https://doi.org/10.1136/archdischild-2019-317160
Jhaveri, S., Patel, B., & Kariya, P. V. (2025). A Prospective Study on the Efficacy of Hypertonic Saline Nebulization in Infants with Acute Bronchiolitis. European Journal of Cardiovascular Medicine, 15(4), 593-595. https://healthcare-bulletin.co.uk/article/a-prospective-study-on-the-efficacy-of-hypertonic-saline-nebulization-in-infants-with-acute-bronchiolitis-3176/
Khanal, A., Sharma, A., Basnet, S., Sharma, P. R., & Gami, F. C. (2015). Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial. BMC pediatrics, 15(115). https://doi.org/10.1186/s12887-015-0434-4
Núñez, F., & Arbo-Sosa, A. (2020). Factores de riesgo de Bronquiolitis en pacientes menores de 2 años. Revista del Instituto de Medicina Tropical, 15(1), 29–36. https://doi.org/10.18004/imt/202015129-36
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología, 74(9), 790–799. https://doi.org/10.1016/j.recesp.2021.06.016
Rodríguez-Fernández, R., González-Sánchez, M. I., Perez-Moreno, J., González-Martínez, F., de la Mata Navazo, S., Mejias, A., & Ramilo, O. (2022). Age and respiratory syncytial virus etiology in bronchiolitis clinical outcomes. The Journal of Allergy and Clinical Immunology: Global, 1(3), 91-98. https://doi.org/10.1016/j.jacig.2022.05.005
Roy, S., Kabir, A. L., Anwer, K. S., Habib, R. B., & Khan, M. (2022). Management of Bronchiolitis with mucolytic agent (3% NaCl) in children in a hospital in Dhaka City without antibiotic. The Journal of Ad-din Women's Medical College, 10(2), 25-30. https://www.banglajol.info/index.php/JAWMC/article/view/67502
Organización Panamericana de la Salud. (2023). Alerta epidemiológica: inicio anticipado del incremento de la actividad de virus respiratorios. [PDF]. Washington, D.C.: OPS/OMS. https://www.paho.org/sites/default/files/2023-09/2023-sep-22-phe-alerta-epi-anticipacion-incremento-virus-respiratorio-esfinal.pdf
Pérez Sanz, J. (2016). Bronquitis y bronquiolitis [PDF]. Pediatría Integral, 20(1), 28–37. https://www.pediatriaintegral.es/wp-content/uploads/2016/xx01/03/n1-028-037_JosuePerez.pdf
Pelletier, J. H., Maholtz, D. E., Hanson, C. M., Nofziger, R. A., Forbes, M. L., Besunder, J. B., Horvat, C. M., & Page-Goertz, C. K. (2024). Respiratory support practices for bronchiolitis in the pediatric intensive care unit. JAMA Network Open, 7(5), e2410746. https://doi.org/10.1001/jamanetworkopen.2024.10746
Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in Review, 40(11), 568–576. https://doi.org/10.1542/pir.2018-0260
Stobbelaar, K., Kool, M., de Kruijf, D., Van Hoorenbeeck, K., Jorens, P., De Dooy, J., & Verhulst, S. (2019). Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: A retrospective study. Journal of paediatrics and child health, 55(9), 1125-1132. https://doi.org/10.1111/jpc.14371
Walsh, R., Costello, L., DiCosimo, A., Doyle, A. M., Kehoe, L., Mulhall, C., O’Hara, S., Elnazir, B., Meehan, J,. Isweisi, E., Semova, G., Branagan, A., Roche, E., & Molloy, E. (2024). Bronchiolitis: Evidence-based management in high-risk infants in the intensive care setting. Pediatric Research, 96, 1560-1567. https://doi.org/10.1038/s41390-024-03340-y
Wang, E. E. L., Milner, R. A., Navas, L., & Maj, H. (1992). Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. American Review of Respiratory Disease, 145(1), 106–109. https://doi.org/10.1164/ajrccm/145.1.106
Wang, Z.-Y., Li, X.-D., Sun, A.-L., & Fu, X.-Q. (2019). Efficacy of 3% hypertonic saline in bronchiolitis: A meta‑analysis. Experimental and Therapeutic Medicine, 18(2), 1338–1344. https://doi.org/10.3892/etm.2019.7684
Vega Mendoza, D. L., Valderrama Ardila, M., Valdivia Álvarez, I., & Valdés Ramírez, O. (2022). Uso de solución salina hipertónica al 3% en niños con bronquiolitis aguda. Revista Cubana de Medicina General Integral, 38(2). https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1408705
Vega-Briceño, L. E. (2021). Actualización de la bronquiolitis aguda [PDF]. Neumología Pediátrica, 16(2), 69–74. https://09c7f1a6bbe60dc0c8c4e0bbc3adef60.cdn.bubble.io/f1717612588370x813461114641790500/pdf_326.pdf
Yu, J.-F., Zhang, Y., Liu, Z.-B., Wang, J., & Bai, L.-P. (2022). 3% nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: A systematic review and meta-analysis of randomized controlled trials. Medicine, 101(43), e31270. https://doi.org/10.1097/MD.0000000000031270
Zaman, N., Majumder, B., Islam, M., Majumder, B. K., Afreen, S., & Shil, P. K. (2023). Randomized Control Trial of 3% Nebulized Hypertonic Saline in Reducing the Length of Hospital Stay in Children with Bronchiolitis. Journal of Rangpur Medical College, 8(1), 40-43. https://doi.org/10.3329/jrpmc.v8i1.65055

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