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Acute Bronchiolitis in Infancy

AcuteBronchiolitis in Infancy

AcuteBronchiolitis in Infancy

PracticeProblem

Anacute bronchiolitis is an infection of the lower respiratory tract avirus known as respiratory syncytial virus (RSV) causes thecondition. According to Zhang, Mendoza-Sassi, Klassen, and Wainwright(2015), the infection is the leading cause of hospitalization inchildren below two years of age around the globe, with the UnitedStates having the largest number of those going for treatments. Inthe United States alone, acute bronchiolitis causes more than onehundred and fifty thousand hospitalizations every year whereas, inthe United Kingdom, the hospital admissions are roughly thirty-threethousand (Zhang,Mendoza-Sassi, Klassen, &amp Wainwright, 2015).The disease also claims several lives every year, with the mostdeaths occurring in the developing countries. However, some therapieshave been proposed and tested for their effectiveness.One of these therapies is the administration of 3% hypertonic saline(Gupta et al., 2016). The purpose of this paper is to examine whetherthe administration of 3% hypertonic saline reduces the duration ofhospitalization compared to the administration of nebulizedbronchodilator.

EvidenceSearch

ResourcesUsed

AcademicSearch Premier (EBSCO), Google Scholar, Proquest, Emeraldinsight, andCourseSmart databases were used to search for journal articlescontaining keywords that described issues about the effectiveness of&quot3% hypertonic saline,&quot those that mentioned &quotacutebronchiolitis,&quot and those that referenced &quotnebulizedhypertonic saline.&quot

SearchTerms

Thefollowing keywords were utilized to ensure maximum uptake of relevantarticles efficacy of 3% hypertonic saline, administration ofnebulized Salbutamol, acute bronchiolitis, nebulized hypertonicsaline, use of nebulized 3% hypertonic saline, children diagnosedwith acute viral bronchiolitis, and hospitalized infants with acuteviral bronchiolitis.

Delimiters

Thekeywords were used so that articles identified could be comprehensiveand relevant to the topic. The articles were intended to provide aperceptive reflection of the effectiveness of administration of 3%hypertonic saline. In this review, only the articles from 2014 to2016 were included. These articles are written in English andincluded titles and abstracts that contain one or more of the searchkey terms identified. The research found twenty sources containinginformation related to the effectiveness of 3% hypertonic saline. Thefive sources used in this paper were selected by thoroughly readingthe abstracts and introductions of the journals. A source wasselected for the paper if it in some way contained relevantinformation that could help to achieve the objective and scope of theassignment. A source was omitted if it focused on acute bronchiolitisbut failed to discuss the available therapies. Therefore, althoughthe twenty journal articles were found to exist in reliabledatabases, the paper found that the five sources selected providedsolid and adequate information on the effectiveness of theadministration of 3% hypertonic saline as far as the reduction ofhospitalization period is concerned.

EvidenceSummary Review

Intheir study, Gupta and colleagues (2016) compared the effects of 3%hypertonic saline and that of nebulized 0.9% normal saline withsalbutamol in children with acute viral bronchiolitis. The results ofthis study indicated that the administration of 3% hypertonic salinereduces the duration of hospitalization as opposed to the addition ofbronchodilators. In almost a similar study, Grewal&amp Goldman (2015) examined if the inhaled hypertonic saline wasrecommended for children with acute bronchiolitis who had beenhospitalized for more than three days. However, the results of thisstudy are conflicting. The reason attributed to this assertion isthat the authors of this article concluded that inhaled nebulizedhypertonic saline had no effect on children hospitalized for morethan three days hence, the treatment would not be recommended.Moreover, the administration of 3% of nebulized hypertonic salinereduces the length of stay for the hospitalized infants with elevendays, which is similar to 0.45 days (Zhang, Mendoza-Sassi, Klassen, &ampWainwright, 2015 Florin, Shaw, Kittick, Yakscoe, &amp Zorc, 2014).

OverallEvidence Synthesis

Thereis a consistency in the results obtained in all the studies. In lightof this, in all the studies reviewed in this assignment, the resultsindicate that the administration of 3% nebulized hypertonic salinereduces the length of stay for children hospitalized with acutebronchiolitis. However, while some of the studies indicate the numberof hours/days reduced, others fail to specify the duration.

Descriptionof Gaps in Knowledge

Asindicated in the above section, the only gap identified is theindication of the number of hours/days that the administration of thehypertonic saline reduces on the hospitalized children. Anothersignificant gap in knowledge is that the majority of the studiesreviewed did not compare the reduction of the duration ofhospitalization between hypertonic saline and nebulizedbronchodilator.

Recommendationsfor Practice

Acuteviral bronchiolitis remains a cause of morbidity in infants. Severalstudies have confirmed that the administration of 3% hypertonicsaline reduces the length of stay for hospitalized children.Therefore, it is recommended that children diagnosed with acutebronchiolitis should be administered with 3% hypertonic salinewithout the addition of bronchodilators because this facilitatestheir healing process hence, reducing their length of stay at thehospital.

References

Florin,T. A., Shaw, K. N., Kittick, M., Yakscoe, S., &amp Zorc, J. J.(2014). Nebulized hypertonic saline for bronchiolitis in theemergency department: a randomized clinical trial.&nbspJAMApediatrics,&nbsp168(7),664-670.

Grewal,S., &amp Goldman, R. D. (2015). Hypertonic saline for bronchiolitisin infants.&nbspCanadianFamily Physician,&nbsp61(6),531-533.

Gupta,H. V., Gupta, V. V., Kaur, G., Baidwan, A. S., George, P. P., Shah,J. C., … &amp Bajaj, K. V. (2016). Effectiveness of 3% hypertonicsaline nebulization in acute bronchiolitis among Indian children: Aquasi-experimental study.&nbspPerspectivesin clinical research,&nbsp7(2),88.

Koker,O., Ozdogan, S., Kose, G., &amp Yildirmak, Z. Y. (2016). Comparisonof the efficacies of normal saline versus hypertonic saline in themanagement of acute bronchiolitis’.&nbspInternationalJournal of Contemporary Pediatrics,&nbsp3(3),795-800.

Zhang,L., Mendoza-Sassi, R. A., Klassen, T. P., &amp Wainwright, C.(2015). Nebulized hypertonic saline for acute bronchiolitis: asystematic review.&nbspPediatrics,peds-2015.

Appendices

Appendix1: Strengths and Weaknesses Table

Author(s), year

Study objective/ intervention or exposures compared

Strengths

Weaknesses

Level of Quality Rating

Zhang, Mendoza-Sassi, Klassen, &amp Wainwright, (2015)

The objective of this study was to examine the efficacy, as well as the safety of nebulized hypertonic saline in children hospitalized with acute viral bronchiolitis

The authors specified the duration reduced, which is 0.45 days

The study failed to compare the effectiveness of hypertonic saline with that of nebulized salbutamol

B

Gupta et al. (2016)

To compare the effects of the administration of 3% hypertonic saline and 0.9% normal saline on the reduction of the length of stay in children hospitalized with acute viral bronchiolitis.

Conceptualization was well developed.

Experimental design – particularly the division of the participants into three groups

Use of paired t-test and Chi-square test for statistical analysis

The authors did not specify the number of days that the administration of the two medications reduced the length of stay.

Number of participants were also not provided

A

Grewal &amp Goldman (2015)

The objective of this study was to determine if inhaled hypertonic saline would be recommended for acute viral bronchiolitis therapy

The study involved a significant number of patients with the condition, which were 81.

The study did not find any statistically significant differences between the two groups of patients

E

Koker, Ozdogan, Kose, &amp Yildirmak (2016)

The study aimed at assessing the various modern physiotherapy approaches for the management of acute viral bronchiolitis

The authors recognize the role that the innate immunity plays as far as the healing process is concerned

The article did not compare the administration of hypertonic saline with nebulized salbutamol

D

Florin, Shaw, Kittick, Yakscoe, &amp Zorc (2014)

The study focused on establishing the variation in treatment and outcomes of administration of hypertonic saline for bronchiolitis across different settings

Conceptualization was well developed.

The article did not compare the administration of hypertonic saline with nebulized salbutamol

C

Appendix2: Summary Evidence Rating Table

Author(s), year

Study objective/ intervention or exposures compared

Design

Sample (n)

Intervention

Outcomes studied (how measured)

Results

Level of Evidence Rating (1-7)

Zhang, Mendoza-Sassi, Klassen, &amp Wainwright, (2015)

The objective of this study was to examine the efficacy as well as the safety of nebulized hypertonic saline in children hospitalized with acute viral bronchiolitis

True experiment with repeated measures

N = 3209

Administration of the medication reduced the length of stay

Administration of the medication reduced the length of stay

2

Gupta et al. (2016)

To compare the effects of the administration of 3% hypertonic saline and 0.9% normal saline on the reduction of the length of stay in children hospitalized with acute viral bronchiolitis.

True experiment with repeated measures

Administration of the medication reduced the length of stay

Administration of the medication reduced the length of stay

1

Grewal &amp Goldman (2015)

The objective of this study was to determine if inhaled hypertonic saline would be recommended for acute viral bronchiolitis therapy

True experiment with repeated measures

N = 81

Administration of the medication reduced the length of stay

Administration of the medication reduced the length of stay

5

Koker, Ozdogan, Kose, &amp Yildirmak (2016)

The study aimed at assessing the various modern physiotherapy approaches for the management of acute viral bronchiolitis

True experiment with repeated measures

Administration of the medication reduced the length of stay

Administration of the medication reduced the length of stay

4

Florin, Shaw, Kittick, Yakscoe, &amp Zorc (2014)

The study focused on establishing the variation in treatment and outcomes of administration of hypertonic saline for bronchiolitis across different settings

True experiment with repeated measures

Administration of the medication reduced the length of stay

Administration of the medication reduced the length of stay

3