New Method, Same Answer: We Do Not Know if Hypertonic Saline Helps Bronchiolitis.

* Abbreviations: LOS — : length of RCT — : randomized controlled TSA — : trial sequential analysisA few years ago at the national Pediatric Hospital Medicine Meeting, presenters in one session lamented the lack of treatment options for the “disease that must not be named”: bronchiolitis. Bronchiolitis is a particularly vexing condition for clinicians who care for children in the inpatient setting. Although we provide supportive care, there is little we can do to alter the course of the disease. Interventions that once held promise, including albuterol, ultimately end up on the “do not try” list because they have no therapeutic benefit and add costs and risk of adverse events to patient care. When the initial trials for nebulized hypertonic saline delivery appeared in the literature, there was hope that it would be used to speed recovery time and shorten the length of stay (LOS). Astute clinicians noted that the initial studies were performed at institutions outside of the United States,1,2 where care algorithms differed and the average LOS tended to be longer. Questions regarding generalizability ensued. Furthermore, researchers of the meta-analyses of the effectiveness of hypertonic saline reached conflicting conclusions.3,4 In this issue of Pediatrics , Harrison et … Address correspondence to Katherine A. Auger, MD, MSc, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 9016, Cincinnati, OH 45229. E-mail: katherine.auger{at}cchmc.org