Nebulized Hypertonic Saline Treatment for Bronchiolitis Shows No Difference in Outcomes vs Normal Saline

In August 2017, Angoulvant and colleagues published the results of a randomized controlled trial in JAMA Pediatrics titled “Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis”. The trial included 777 infants presenting in the Emergency Department with a first episode of acute bronchiolitis, but who were otherwise healthy. The results suggest that hospital admission rates were statistically similar for the two modalities with 48.1% of infants in the Hypertonic Saline group admitted by 24 hours and 52.2% of infants admitted in the Normal Saline group (adjusted risk difference, –3.2%; 95%CI, –8.7%to 2.2%; P = .25).

Additionally, the trial found that mild adverse events occurred 8.9% of the time in the Hypertonic Saline group and only 3.9% of the time in the Normal Saline group. No serious adverse events occurred with either treatment though the authors note that their results strongly argue against the use of Hypertonic Saline treatment for the type of studied population from a risk-benefit perspective.

Hypertonic Saline has been used in bronchiolitis treatment because it rehydrates the airway mucosa and promotes mucociliary clearance.[1]

Another well-modelled method of hydration is by inspiration of heated humidified conditioned gas.[2] Vapotherm high velocity therapy delivers an optimal blend of heated and humidified gas to mobilize secretions, protect airway mucosa, and promote bronchodilation.

Learn more about a 2018 clinical trial of HFNC for patients with Bronchiolitis

[1] Mandelberg A, Amirav I. Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Pediatr Pulmonol. 2010;45(1):36–40. (
[2] Williams R1, Rankin N, Smith T, Galler D, Seakins P. “Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa.” Critical Care Medicine. 1996 Nov;24(11):1920-9.

This webpage contains links to third party abstracts and/or publications. With respect to those materials, please note that Vapotherm’s Hi-VNI® technology is a tool for treating the signs and symptoms of respiratory distress in patients for whom prescribers desire to add heat and moisture to breathing gases. The linked materials may describe certain outcomes in relation to the use of Vapotherm’s Hi-VNI Technology, but individual results may vary. Practitioners should refer to the full indications for use and operating instructions of any products referenced herein before prescribing them.