A prospective randomised trial comparing nasogastric with intravenous hydration in children with bronchiolitis (protocol) The comparative rehydration in bronchiolitis study (CRIB) (original) (raw)
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BACKGROUND:Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospital admission. Hydration is a mainstay of treatment, but insufficient evidence exists to guide clinical practice. We aimed to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants. METHODS:In this multicentre, open, randomised trial, we enrolled infants aged 2-12 months admitted to hospitals in Australia and New Zealand with a clinical diagnosis of bronchiolitis during three bronchiolitis seasons (April 1-Oct 31, in 2009, 2010, and 2011). We randomly allocated infants to nasogastric hydration or intravenous hydration by use of a computer-generated sequence and opaque sealed envelopes, with three randomly assigned block sizes and stratified by hospital site and age group (2-<6 months vs 6-12 months). The primary outcome was length of hospital stay, assessed in all randomly assigned infants. Secondary outcomes included rates of intensive-care unit admission, adverse events, and success of insertion. This trial is registered with the Australian and New Zealand clinical trials registry, ACTRN12605000033640. FINDINGS:Mean length of stay for 381 infants assigned nasogastric hydration was 86·6 h (SD 58·9) compared with 82·2 h (58·8) for 378 infants assigned intravenous hydration (absolute difference 4·5 h [95% CI -3·9 to 12·9]; p=0·30). Rates of admission to intensive-care units, need for ventilatory support, and adverse events did not differ between groups. At randomisation, seven infants assigned nasogastric hydration were switched to intravenous hydration and 56 infants assigned intravenous hydration were switched to nasogastric hydration because the study-assigned method was unable to be inserted. For those infants who had data available for successful insertion, 275 (85%) of 323 infants in the nasogastric hydration group and 165 (56%) of 294 infants in the intravenous hydration group required only one attempt for successful insertion. INTERPRETATION:Intravenous hydration and nasogastric hydration are appropriate means to hydrate infants with bronchiolitis. Nasogastric insertion might require fewer attempts and have a higher success rate of insertion than intravenous hydration. FUNDING:Australian National Health and Medical Research Council, Samuel Nissen Charitable Foundation (Perpetual), Murdoch Children's Research Institute, Victorian Government.
Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis
Emergency medicine Australasia : EMA, 2016
Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more cost-effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non-oral hydration. No Australian cost data exist to aid clinicians in decision-making around interventions in bronchiolitis. Cost data collections included hospital and intervention-specific costs. The economic analysis was reduced to a cost-minimisation study, focusing on intervention-specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat. Intervention costs were greater for IVH than NGH ($113 vs 74;costdifferenceof74; cost difference of 74;costdifferenceof39 per child). The intervention-specific cost advantage to NGH was robust to inter-si...
Utilization of Nebulized 3% Saline in Infants Hospitalized with Bronchiolitis
The Journal of Pediatrics, 2015
To describe utilization of 3% hypertonic saline (HTS) in hospitalized infants and to evaluate the association between HTS use and length of stay (LOS) in a real-world setting. This multicenter retrospective cohort study included infants ≤12 months hospitalized with bronchiolitis between October 2008 and September 2011 using the Pediatric Health Information System. HTS use was categorized as trial, rescue, daily, or sporadic. Differences in LOS were compared after matching daily HTS recipients and nonrecipients on propensity score. There were 63 337 hospitalizations for bronchiolitis. HTS was used in 24 of 42 hospitals and 2.9% of all hospitalizations. HTS use increased from 0.4% of visits in 2008 to 9.2% of visits in 2011. There was substantial variation in HTS use across hospitals (range 0.1%-32.6%). When used, HTS was given daily during 60.6% of hospitalizations, sporadically in 10.4%, as a trial in 11.3%, and as a rescue in 17.7%. The propensity score-matched analysis of daily HTS recipients (n = 953) vs nonrecipients (n = 953) showed no difference in mean LOS (HTS 2.3 days vs nonrecipients 2.5 days; β-coefficient -0.04; 95% CI -0.15, 0.07; P = .5) or odds of staying longer than 1, 2, or 3 days. Daily HTS recipients had a 33% decreased odds of staying in the hospital &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 days compared with nonrecipients (OR 0.67; 95% CI 0.47, 0.97; P = .03). Variation in HTS use and the lack of association between HTS and mean LOS demonstrates the need for further research to standardize HTS use and better define the infants for whom HTS will be most beneficial.
Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?
Colombia Medica, 2016
Objective: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. Methods: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting β2-agonist (salbutamol) +hydration; nebulized short-acting β2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. Results: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. Conclusions: IV hydration is not effective on length of...
Journal of pediatric critical care, 2019
Background and objective: Acute bronchiolitis, the most common lower respiratory tract infection,is the leading cause of hospitalization among infants. The objective of the study is to compare the effect of 7% hypertonic saline (HS) with 3% HS among infants with acute bronchiolitis. Methods: A total of 96 infants between the age group of 2 to 24 months with acute bronchiolitis and Bronchitis Severity Score (BSS)> 4 were included in this double-blinded, randomized controlled trial. The infants were grouped based on the therapy administered: group A (7% HS with L-adrenaline, n = 48) and group B (3% HS with L-adrenaline, n = 48).The prime outcome measure was Length of Hospital Stay (LHS). Whereas, the secondary outcome measures included BSS, heart rate, oxygen saturation, need and durationof supplemental oxygen, and adverse events. Statistical analysis was performed using SPSS 21 software. Results and Conclusion: Patient's baseline characteristics were alike in both the groups. The length of the hospital stay was 4.34 ± 1.01 days in 7% HS group and 4.59 ± 1.10 days in 3% HS group (P > 0.05). Treatment with 7% HS and 3% HS with adrenaline were associated with a decreased BSS and reduced length of hospital stay without any adverse effects among infants with acute bronchiolitis.
Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants
Balkan Medical Journal, 2016
Background: There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A-0.9% saline/salbutamol, group B-3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis.
DergiPark (Istanbul University), 2016
Background: There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A-0.9% saline/salbutamol, group B-3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis.
2019
Introduction High-flow nasal cannula (HFNC) is a non-invasive form of respiratory support used increasingly in bronchiolitis. HFNC provides a variable amount of positive pressure similar to continuous positive airway pressure (CPAP). The positive pressure in CPAP can distend and loosen oesophageal sphincter pressure leading to increased reflux. It is unclear if HFNC causes a similar action. Feeding tubes are used to provide nutrition and hydration to patients that are unable to safely take oral feedings. If there is increased reflux from HFNC, this would increase the risk of aspiration. Our institution places nasoduodenal tubes (NDT) to eliminate this risk. The purpose of the study is to infer if there is a difference between NDT and nasogastric tube (NGT) feeding with regard to length of respiratory support, number of emesis, number of chest X-rays and readmission/emergency room revisit rates. Methods and analysis Patients with bronchiolitis, on high-flow nasal cannula, and whose p...
International journal of immunopathology and pharmacology
The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days...
Bangladesh Journal of Child Health, 2018
Background: Acute bronchiolitis is leading cause of hospitalization in infants below 2 years of age. Bronchiolitis being a viral disease, there is no effective treatment. 3% nebulized hypertonic saline and 0.9% nebulized normal saline are often used, although there is disagreement over their efficacy. The aim of this study was to evaluate the efficacy of 3% hypertonic saline in children with acute bronchiolitis in reducing clinical severity and length of hospital stay. Methodology: A randomized control trial carried out in the Department of Pediatrics, Dhaka Medical College Hospital from January 2013 to December 2013.Ninty children from 1 month to 2 years of age hospitalized with clinical bronchiolitis were randomized to receive 3% nebulized hypertonic saline(Group-I) or 0.9% nebulized normal saline (Group-II). Nebulization was done 8 hourly until discharge. Outcome variable were clinical severity score, duration of oxygen therapy and length of hospital stay. Results: Baseline clini...