hypertonic saline or high volume normal saline for viral bronchiolitis
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7/23/2019 Hypertonic Saline or High Volume Normal Saline for Viral Bronchiolitis
http://slidepdf.com/reader/full/hypertonic-saline-or-high-volume-normal-saline-for-viral-bronchiolitis 1/5
\ighbtrhf \uejmdmem`y 79>6?‖7< (;<2<)
Hdvhtig Fmjjidtbry
Aypirtmdhf Vbehdi mr Ah`a _meuji Dmrjbe Vbehdi omr_hrbe Krmdfahmehths> Jifabdhsjs bdg [bthmdbei
Bvh`gmr Jbdgiekir`, JG2* bdg Hsrbie Bjhrbv, JG
;
Ciy wmrgs> aypirtmdhf sbehdi3 vhrbe krmdfahmehths3 [V_3 jufus feibrbdfi3 k; b`mdhst3
dmrjbe sbehdi.
HDW[MGYFWHMD
Hd rifidt yibrs bdg pbrthfuebrey hd tai ebst 9 yibrs, tairi
abvi kiid sukstbdthbe bgvbdfis hd mur udgirstbdghd` mo tai
jifabdhsjs `mvirdhd` jufus feibrbdfi (JF) hd aibeta
bdg ghsibsi. Waisi abvi gijmdstrbtig tai rmei mo
aygrbthmd mo tai bhrwby surobfi ehquhg (BVE) bdg tai
hjpmrtbdfi mo hdabeig aypirtmdhf sbehdi omr riaybgrbthmd
bdg abvi kiid rifidtey rivhiwig.2‖ 6
Krhiy, ht wbs su``istig tabt JF obheuri hs b gmjhdbdt
obftmr dmt mdey hd FO kut hd jmst bhrwby ghsibsis bdg tabt
aygrbthmd hs tai gmjhdbdt vbrhbkei `mvirdhd` JF hd bee
bhrwby ghsibsis.;,6
Wahs wbs besm omudg tm ki trui ividhd dmrjbe suknifts7 bdg ourtairjmri, ht abs kiid dmtig,
tabt ixbfirkbthmds hd jbdy bhrwby ghsibsis risuet ormj
hdtirjhttidt fbtbstrmpahf obheuris mo JF gui tm giaygrb-
thmd mo BVE motid trh``irig ky vhrbe hdoifthmds. Waus,
tairbpy tm jbhdtbhd BVE aygrbthmd hs prmkbkey hjpmrtbdt
gurhd` vhrbe ixbfirkbthmds dmt mdey hd FO pbthidts kut hd bee
farmdhf bhrwby ghsibsis.;,9
Hssuis frufhbe tm udgirstbdghd` tai pmstuebtig jifab-
dhsj hdvmevhd` aypirtmdhf sbehdi hdabebthmd tribtjidt hd
[V_ krmdfahmehths whee ki gisfrhkig hd jmri gitbhe airi.
\MVVHKEI JIFABDHVJV MO BVE GIAXG[BWHMD
HD _H[BE K[MDFAHMEHWHV
Ioflfhidt feibrbdfi riquhris tai fmmrghdbtig hdtirbfthmd
mo twm sipbrbti ebyirs> bd mvireyhd` trbdspmrtig jufus
ebyir (JE) bdg b sipbrbti, ghsthdft idvhrmdjidt dibr
tai fiee surobfi fbeeig pirhfhehbry ehquhg (\FE). BVE
fmjprhsis kmta mo taisi ebyirs.; Oh`uri 2 hs b sfaijbthf
riprisidtbthmd mo tai prmpmsig jifabdhsjs mo BVE
giaygrbthmd hd [V_ krmdfahmehths (Oh`. 2K,F) fmjpbrig
tm dmrjbes (Oh`. 2B) bdg FO pbthidts (Oh`. 2G). Vhdfi
bhrwby iphtaiehb bri wbtir pirjibkei, wbtir jmvis tm
iqubehzi ieiftrmeyti fmdfidtrbthmds omeemwhd` hdwbrg
bfthvi bksmrpthmd mo Db tarmu`a IDbF tairiky fbushd`
giaygrbthmd mo tai BVE bdg mutwbrg omeemwhd` Fe
trbdspmrt tarmu`a kmta FOW[ bdg Fbefhuj bfthvbtig
faemrhgi fabddies (FbFF), taus aygrbthd` tai BVE.
Ky bfthvbthd` tai B;1 rifiptmr (rig), bgidmshdi
sthjuebtis tai FOW[ tm sifriti Fe bdg tm bttidubti IDbF
bfthvhty, taus aygrbthd` tai BVE. Hd vhvm, BW\ bfthvbtis tai
\;X; rifiptmr (keui) taus sthjuebthd` FbFF tm sifriti Fe
bdg ghriftey bttidubti IDbF bfthmd, taus aygrbthd` tai
BVE. BW\, wahfa ribfais mdey di eh`hkei, hdiooifthvi
fmdfidtrbthmds hd stbthf thssui fueturis, ribfais b ah`a
fmdfidtrbthmd hd vhvm (hd jmvhd` eud`s) bdg hs prmkbkey
tai jmst hjpmrtbdt aygrbthd` bdg fmjpidsbthd` sthjueusomr ri`uebthd` tai BVE wbtir fmdtidt.; Wahs hdfribsi hd
BW\ fmdfidtrbthmd, tabt mffurs mdey hd vhvm, hs gui tm
b jifabdhsj fbeeig jifabdmtrbdsgufthmd hd wahfa fiees
fmdvirt b jifabdhfbe sthjueus hdtm faijhfbe bfthvhty.
Hd tahs fbsi, tai pabshf jmthmd mo tai bhrwby mw
(eud` hdbthmd/gibthmd bdg pbrthfuebrey bffieirbthmd
bdg gifieirbthmd) prmgufis b saibr striss wahfa hs
2Wai \ighbtrhf \uejmdbry Ydht, Wai Ighta Pmeosmd Jighfbe Fidtir
(Boflehbtig whta Wai Vbfceir Vfamme mo Jighfhdi, Wie Bvhv Ydhvirshty,
Hsrbie), Amemd, Hsrbie
;Wai \ighbtrhf Gipbrtjidt, [. Vhioo Amsphtbe, Vboig, Hsrbie (Boflehbtig whta
tai Wifadhmd Vfamme mo Jighfhdi Abhob, Hsrbie2)
*Fmrrispmdgidfi tm> Bvh`gmr Jbdgiekir`, Ghriftmr, \ighbtrhf \uejmdbry
Ydht, Wai Gipbrtjidt mo \uejmdbry Jighfhdi bdg \ighbtrhfs, Wai Ighta
Pmeosmd Jighfbe Fidtir, ?;, Abemfabjhj Vtriit, Amemd 912<<, Hsrbie.
I-jbhe> bvh`gmrjLditvhshmd.dit.he
[ifihvig 2 Nudi ;<<83 [ivhsig 8 Bu`ust ;<<83 Bffiptig 2; Bu`ust ;<<8.
GMH 2<.2<<;/ppue.;2219
\ukehsaig mdehdi 1 Gifijkir ;<<8 hd Pheiy HdtirVfhidfi
(www.hdtirsfhidfi.wheiy.fmj).
;<<8 Pheiy-Ehss, Hdf.
7/23/2019 Hypertonic Saline or High Volume Normal Saline for Viral Bronchiolitis
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tbd`idthbe tm tai bphfbe iphtaiehbe fiee jijkrbdi (hd
fmdtrbst tm tai dmrjbe striss tabt hs pirpidghfuebr) bdg
fbusis tai iphtaiehbe fiee tm rieibsi ixtrb-fieeuebr BW\ taus
aygrbthd` tai BVE (Oh`. 2B). Wahs ebttir jifabdhsj abskiid samwd tm ki ah`aey vuedirbkei tm vhrbe hdnury
pbrthfuebrey bs mffurs hd [V_ hdoifthmds.;
Jbhdtbhdhd` dmrjbe aih`at mo tai \FE (brmudg 0jj) hs
frufhbe omr jbhdtbhdhd` dmrjbe bhrwby jufmfhehbry
feibrbdfi (JFF) sm tabt tai jmvhd` thps mo tai fhehb
whee prifhsiey fmdtbft tai emwir jbr`hd mo tai JE. Wahs
hs jbhdtbhdig ky tai JE bfthd` bs b wbtir risirvmhr
sieifthviey bksmrkhd` wbtir hd rispmdsi tm ixfiss aygrb-
thmd bdg hdfribshd` tai JFF tm supir-dmrjbe rbtis
(Oh . 2B). Wahs supir-dmrjbe JFF wbs gijmdstrbtig
hd dmrjbe suknifts wam hdabeig aypirtmdhf sbehdi (AV)
birmsmes.7
Hd fmdtrbst, ht hs su``istig tabt waid giay-grbthmd mo tai BVE mffurs hd rispmdsi tm b riebthviey jheg
[V_ hdoifthmd, ixtrb-fieeuebr BW\ fmdfidtrbthmds bri
gipeitig, taus giaygrbthd` tai BVE. Wai JE taid gmdbtis
wbtir tm prisirvi bt eibst smji JF wahei jbhdtbhdhd` tai
\FE aih`at femsi tm tai dmrjbe bpprmxhjbtiey 0 jj bdg
risuethd` hd JE giaygrbthmd (; bdg Oh`. 2K). Amwivir,
waid tahs gmdmr jifabdhsj hs ixabustig, tai JE abs dmjmri wbtir tm gmdbti, tai \FE jby stbrt tm fmdtrbft tm tai
pmhdt tabt JFF hs hjpmsshkei (Oh . 2F). Bs FO iphtaiehuj,
wahfa ebfcs FOW[ (Oh`. 2G), hs taus tmtbeey gipidgidt md
BW\, tai \FE fmdtrbfthmd mffurs ibrey, ivid hd FO bhrwbys
ixpmsig tm riebthviey jhdmr vhrbe hdnury hd FO ixbfir-
kbthmds (; bdg Oh`. 2G).
Hd sjbee kbkhis suooirhd` ormj siviri bfuti [V_
krmdfahmehths, tai ah`a embg mo [V_ hdoifthmd hd tai sjbee
krmdfahmeis, prmkbkey fbusis b fmdshgirbkei rigufthmd mo
ixtrb fieeuebr BW\ tabt hs frufhbe omr jbhdtbhdhd` BVE
aygrbthmd hd vhvm. Hd bgghthmd, tai dmd-spifhflf pbtamem`-
hfbe hjpbft mo [V_ hdoifthmd sufa bs tai fytmtmxhf iooiftsmd fiees, fhehbry gbjb`i bdg fytmchdi rieibsi risuets hd
jufus peu``hd` mo sjbeeir bhrwbys. Pi aypmtaishzi tabt
tai prmtifthvi iooifts mo tai JE risirvmhr bdg tabt mo tai
sthee oudfthmdhd` FOW[ hd tai rijbhdhd` iphtaiehbe fiees
tabt wiri dmt jbsshviey gbjb ig ky tahs [V_ hdbjjb-
thmd, hs prmkbkey ixfiigig, taus gipeithd` dmt mdey tai
jufus ebyir wbtir fmdtidt kut besm gbjb`hd` tai BVE
iphtaiehbe brfahtifturi taus rigufhd` tai aih at, mo tai \FE
bdg hjpbhrhd` JF. Wahs ehciey fmdtrhkutis tm bhrwby
jufus peu``hd`, bhrwby mkstrufthmd, aypirhdbthmd bdg
btieiftbshs tabt besm fabrbftirhzi siviri [V_ hdoifthmd.
BKK[I_HBWHMDV
BVE Bhrwby surobfi ehquhg
\FE \irhfhehbry ehquhg
JE Jufus ebyir
JF Jufus feibrbdfi
JFF Jufmfhehbry feibrbdfi
FV Fehdhfbe sfmri
\ighbtrhf \uejmdmem`y
Oh`. 2. \mstuebtig jifabdhsj hd vhvm, ixpebhdhd` BVE giaygrbthmd hd [V_ krmdfahmehths bs
fmjpbrig tm dmrjbe bdg FO>(B) dmrjbe,(K) jheg [V_ krmdfahmehths> (F) siviri [V_ krmdfahmehths,
(G)gurhd` vhrbehdoifthmd hd FO. Wahsfl`uri wbsjmghflig pbrthfuebrey omr [V_ krmdfahmehths, whtatai
pirjhsshmd bdg tai fmurtisy mo [bdgiee VA bdg Gmdbegsmd VA, kmta ormjtai Ydhvirshty mo Dmrta
Fbrmehdb bt Fabpie Ahee.
Aypirtmdhf Vbehdi 60
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Amwivir, betamu`a obhrey ribsmdbkei bs b wby mo ixpebhd-
hd` tai mksirvbthmds, tahs ebttir aypmtaishs abs divir kiid
prmvid hd b prmpirey gish`dig pebfikm-fmdtrmeeig stugy
riifthd` tai fmjpeix hdtirbfthmds tabt mffur hd vhvm, hd
tai vbrhmus krmdfahbe bdg krmdfahmebr bhrwbys hd sjbee
kbkhis gurhd` tai ivmeuthmd mo dbturbeey mffurrhd` bfuti
[V_ krmdfahmehths. Wamu`a giaygrbthmd mo tai BVEbdg JF gysoudfthmd udgmuktigey mffur, bt prisidt wi
gm dmt cdmw tm wabt ixtidt. Pi fbd mdey prisuji tabt,
bt smji stb`i, bdg hd smji krmdfahmeis mo taisi jmri
siviriey booiftig kbkhis, tai hjpbft mo [V_ hdoifthmd md
tai BVE hs prmkbkey hdtirjighbti kitwiid Oh`uri 2K bdg
G bdg kitwiid udhdoiftig dmrjbe BVE bdg tai viry
ixtriji fmdghthmds tabt mffur hd vhrbe hdoiftig FO BVE
(Oh`. 2B‖ G).
[BWHMDBEI MO AV BI[MVME W[IBWJIDW
HD [V_ K[MDFAHMEHWHV
Hdobdts whta bfuti vhrbe krmdfahmehths waiizi kut bs tai
pbtampayshmem`y mo krmdfahmehths hs quhti ghsthdft ormj
tabt mo bstajb, taisi hdobdts bri eiss ho bt bee rispmdshvi
tm krmdfamghebtmrs? mr stirmhgs.0 Krmdfahmehths hs b vhrbe
hdoifthmd mo tai krmdfahbe bdg krmdfahmebr iphtaiehuj,
whta suksiquidt pirhkrmdfahmebr jmdmdufeibr hdfletrbthmd
bdg iphtaiehbe fiee difrmshs, prmomudg suk-jufmsbe igijb,
hdfribsig sifrithmd mo jufus bdg tairiomri bd hdfribsi
hd jufhd/wbtir rbthm1 tabt fbusis riebthvi giaygrbthmd mo
BVE.; Jmrimvir, [V_, ky hdfribshd` BW\bsi eivies
gifribsis ixtrb fieeuebr BW\ bdg tairiomri risuets hd emss
mo IDbF hdahkhthmd (hdfribshd` Db bksmrpthmd) bdg emss mo tai bttidubthmd mo mutwbrg sifrithmd mo faemrhgi. Waus,
jmri wbtir whee jmvi ormj tai BVE tm tai suk-jufmsb
bemd` whta taisi ieiftrmeytis (Oh`. 2K,F). Wahs whee risuet
hd jmri giaygrbthmd mo tai BVE, bdg b gifribsi hd tai
aih`at mo tai jufus ebyir (Oh`s. 2K bdg ;). Waus
aypmtahfbeey, hd jmri siviriey booiftig krmdfahmebr bribs,
tai BVE prmtifthvi aygrbthd` jifabdhsj fbd ki hjpbhrig
taus gipeithd` dmt mdey tai jufus ebyir‘s wbtir fmdtidt kut
besm gbjb`hd` tai BVE, bdg iphtaiehbe brfahtifturi wahei
tai gipeitig aih`at mo tai \FE hjpbhrs JF (Oh`. 2F).
Waus, bpprmprhbti tairbpy just aygrbti tai BVE, gifribsitai suk-jufmsbe igijb bdg hjprmvi tai jufus raimem`hf
prmpirthis (iebsthfhty bdg vhsfmshty) bdg taus hjprmvi JF.
Aypirtmdhf sbehdi jby, hd taimry, rivirsi smji mo taisi
pbtampayshmem`hfbe bkdmrjbehthis hd bfuti vhrbe krmdfahm-
ehths. Hd vhtrm, tai bgghthmd mo aypirtmdhf sbehdi hdfribsis
bhrwby surobfi tahfcdiss, gifribsis iphtaiehbe igijb,8
hjprmvis jufus raimem`hf prmpirthis (iebsthfhty bdg
vhsfmshty), bdg bffieirbtis jufus trbdspmrt rbtis.8,2<
Hd vhvm, aypirtmdhf sbehdi hdabebthmd hdfribsis tai rbti
mo jufmfhehbry trbdspmrt ivid hd dmrjbe suknifts whta
dm ivhgidfi mo giaygrbthmd, jufus aypir-sifrithmd mr
suk-iphtaiehbe igijb.
7
Bgghthmdbe Hjpmrtbdt Jmgis mo Bfthmd moBirmsmehzig AV Wribtjidts hd [V_ Krmdfahmehths
Pairibs aygrbthmd mo tai BVE hs fmdshgirig tai jbhd
jmgi mo bfthmd, bgghthmdbe hjpmrtbdt jifabdhsjs bri
bttrhkutig tm tai iooift mo AV ky wahfa AV hjprmvis JF
ky fhehbry mr fmu`a bfthmds. Aypirtmdhf sbehdi kribcs tai
hmdhf kmdgs whtahd tai jufus `ie. Wahs, hd turd, rigufis tai
gi`rii mo frmss-ehdchd` bdg idtbd`eijidts,22 taus hjprmv-
hd` jufus raimem`y. AV hdfribsis fhehbry kibt oriquidfy
vhb tai rieibsi mo prmstb`ebdghd I;.9 Bgghthmd mo aypir-tmdhf sbehdi rbhsis tai hmdhf fmdfidtrbthmd hd tai jufus bdg
krhd`s bkmut b fmdomrjbthmdbe fabd`i ky ‑‑sahieghd`‘‘ tai
di`bthvi fabr`is, tairiky rigufhd` ripueshmd. Wahs risuets
hd b jmri fmjpbft jufus jbfrmjmeifuei, bdg jmri
\ighbtrhf \uejmdmem`y
Oh`. ;. Vhjpehflig sfaiji bssujhd` mdey msjmthf omrfis tm fmdtrme wbtir trbdspmrt.
61 Jbdgiekir` bdg Bjhrbv
7/23/2019 Hypertonic Saline or High Volume Normal Saline for Viral Bronchiolitis
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iooifthvi fmu`a-gipidgidt JF.2; Bhrwby surobfi ehquhg
aypirmsjmebrhty fbd rieibsi jighbtmrs fbpbkei mo idabdf-
hd` fhehbry bfthvhty.9 Jmrimvir, ky bksmrkhd` wbtir ormj
tai jufmsb bdg suk-jufmsb, aypirtmdhf sbehdi smeuthmd
fbd taimrithfbeey rigufi igijb mo tai bhrwby wbee hd
hdobdts whta bfuti krmdfahmehths (26,27 bdg Oh`. ;). Aypir-
tmdhf sbehdi hdabebthmd fbd besm fbusi sputuj hdgufthmdbdg fmu`a, wahfa fbd aiep tm feibr tai sputuj ormj tai
bhrwbys bdg taus hjprmvi bhrwby mkstrufthmd.26
FEHDHFBE VWYGHIV YVHD@ _B[HMYV DbFeFMDFIDW[BWHMDV BDG GMVIV HD[V_ K[MDFAHMEHWHV
Ghstheeig Pbtir (<% DbFe)
Vjhta it be.29 usig ghstheeig wbtir (<% DbFe) bs b
‑‑pebfikm‘‘ bdg gijmdstrbtig tabt birmsmehzig rhkbvhrhd
fmdshgirbkey rigufig tai gurbthmd mo jifabdhfbe vidtheb-thmd bdg amsphtbehzbthmd fmjpbrig tm ‑‑pebfikm‘‘ hd hdobdts
whta bfuti [V_ krmdfahmehths. Mkvhmusey, ht wbs dmt tai
rhkbvhrhd tabt hjprmvig tai tribtjidt `rmup kut tai
bgvirsi iooift mo tai ghstheeig wbtir tabt abg bd bgvirsi
iooift md tai ‑‑pebfikm‘‘ `rmup (Oh`. 2). Wai ‑‑kidiflfhbe‘‘
iooift mo rhkbvhrhd fmueg dmt ki gupehfbtig suksiquidtey hd
privhmusey aibetay hdobdts whta [V_ krmdfahmehths bdg
mdey taid wbs ht bpprifhbtig tabt ghstheeig wbtir wbs dmt bd
bpprmprhbti pebfikm bdg tai BB\ fabd`ig hts privhmus
stbtijidt ormj ‑‑rhkbvhrhd samueg ki usig‘‘ tm ‑‑rhkbvhrhd
jby mdey ki fmdshgirig omr fahegrid whta sirhmus udgir-
eyhd` ghsmrgirs.‘‘1 Wahs hs rieivbdt tm mur tmphf hd twm
rispifts. Ohrstey, tahs tibfais us tabt wi samueg dmt bffiptwhtamut quisthmd b ‑‑pebfikm iooift‘‘ ivid waid piir
rivhiwig ky b riputbkei nmurdbe.29 Ohdbeey, ho ghstheeig
wbtir hs dmt bpprmprhbti, ht bppibrs tabt tairi hs dm ribeey
bgiqubti pebfikm omr AV stughis. Wahs samueg ki tbcid hdtm
bffmudt hd tai gish`d mo outuri stughis.
Aypirtmdhf Vbehdi (6%)
Hd tarii rbdgmjhzig gmukei kehdg pebfikm fmdtrmeeig
stughis Jbdgiekir it be.,26
Vbrriee it be.,27
bdg Wbe it be.2?
fmdflrjig tai io flfbfy mo AV hjprmvhd` tai gurbthmd mo
amsphtbehzbthmd bdg fehdhfbe sfmris, kmta hd bjkuebtmrybdgamsphtbehzig hdobdts whta [V_ krmdfahmehths. Amwivir bs
stbtig hd b Nuey ;<<0 rivhiw,6 taisi stughis wiri bee
fmdguftig ky tai sbji risibrfa `rmup bdg betamu`a
prmjhshd` diigig tm ki fmdflrjig ky mtairs hd b jueth-
fidtir trhbe. Vhdfi taid, Cuzhc it be.20 pukehsaig b
prmspifthvi, rbdgmjhzig, gmukei-kehdg, pebfikm fmd-
trmeeig, jueth-fidtir trhbe (tarii fidtirs omr 6 yibrs) bdg
fmdflrjig tai ibrehir risuets. Hd ebti ;<<1, ^abd` it be.21
pukehsaig b Fmfarbdi Gbtbkbsi [ivhiw tm sujjbrhzi tai
iooift mo dikuehzig AV hd taisi pbthidts. Ahs rivhiw
hdfeugig omur gmukei kehdg rbdgmjhzig trhbes hdvmevhd`
;97 hdobdts. Bdbeyshs mo tai pmmeig gbtb, su``istig tabt
tairbpy whta dikuehzig6% sbehdi sh`dhflfbdtey rigufig tai
gurbthmd mo amsphtbehzbthmd bdg hjprmvig tai fehdhfbe
sivirhty sfmri hd hdobdts whta bfuti vhrbe krmdfahmehths. Wai
hjpehfbthmds omr prbfthfi mo tahs rivhiw wiri tabt, `hvid
tai fehdhfbeey rieivbdt kidiflt bdg `mmg sboity prmflei,
dikuehzig 6% sbehdi usig hd fmdnudfthmd whta krmdfamgh-ebtmrs samueg ki fmdshgirig bd iooifthvi bdg sboi tribtjidt
omr hdobdts whta vhrbe krmdfahmehths.
Ah`a _meuji Dmrjbe Vbehdi (<.8%)
Hd tahs hssui mo tai nmurdbe, Bdhe it be.28 pukehsaig b
rbdgmjhzig gmukei kehdg pebfikm fmdtrmeeig stugy tm
hdvisth`bti tai iooifthvidiss mo dikuehzig sbekutbjme,
iphdiparhdi bdg 6% sbehdi fmjpbrig tm ah`a vmeuji
dmrjbe sbehdi hd tai tribtjidt mo bfuti jheg vhrbe
krmdfahmehths. Bee omur `rmups rifihvig twm hdabebthmds
mo tai tribtjidt gru`s hd tai ijir`idfy gipbrtjidt (thji< bdg 6< jhd). Waiy samwig tabt FV sfmris botir 6<, ?<,
bdg 2;< jhd wiri sh`dhflfbdtey bdg prm`risshviey kittir
tabd tai kbsiehdi vbeuis. Dm dikuehzig tairbpy mpthmds
hdfeughd` 6% sbehdi wiri jmri iooifthvi tabd mtairs.
Amwivir, bee tribtjidt jmgbehthis hdfeugig ah`a gmsi
DbFe ghssmevig hd 1 je (0; j` omr tai sbekutbjme,
iphdiparhdi bdg dmrjbe sbehdi `rmups bdg ;7< j` omr
tai 6% sbehdi `rmup).
Hd vhiw mo rifidt di`bthvi risuets mo kitb b`mdhst
tribtjidt hd hdobdts whta krmdfahmehths,;; tai jbhd bggig
vbeui mo tahs stugy tm tai furridt ehtirbturi jby ki tabt
b ebr`i jbss mo DbFe giehvirig bs ah`a vmeuji dmrjbe
sbehdi hdabebthmds fmueg ki suo flfhidt tm fbusi sh`dhflfbdthjprmvijidt hd jheg bfuti vhrbe krmdfahmehths.
Amwivir, Bdhe‘s stugy samueg dmt ki hdtirpritig bs
fmdflrjbthmd omr b di`bthvi iooift mo aypirtmdhf sbehdi
hdabebthmdhd bfuti vhrbe krmdfahmehthsbdg wbs dmt hdfeugig
hd tai stughis bssijkeig tm ivbeubti tai hdabeig AV iooift
omr tai omeemwhd` ribsmds> Wahs hs b stugy mo viry jheg
krmdfahmehths tabt hjprmvig fmdshgirbkey bdg rbphgey
(hd 2;< jhd) botir mdey twm hdabebthmds mo 1 je <.8%
DbFe `hvid hd tai ijir`idfy gipbrtjidt. Wai tribtjidt
fmdshstig mo b shd`ei gmsi hd fmdtrbst tm tai bkmvi
jidthmdig stughis tabt fmdthduig omr 6 ‖? gbys.21 Wai
hjprmvijidt wbs sm grbjbthf tabt bee mo taisi fahegridfmueg ki ghsfabr`ig amji whtahd ; ar waid tai FV abg
hjprmvig ormj 6.? 2tm2.1 2.7. Wai M; sbturbthmd bdg
puesi rbti wiri dmrjbe ormj tai stbrt.
Fmdshgirhd` tahs bdg tai obft tabt <.8% sbehdi hs dmt b
pebfikm (7 bdg Oh`. ;), ht hs ivhgidt tabt, hd fmdtrbst tm tai
rifidt ehtirbturi, aypirtmdhf 6% sbehdi wbs ‑‑dmt jmri
iooifthvi‘‘ tabd <.8% sbehdi. Mkvhmusey, tairi wbs dm
ourtair hjprmvijidt bfahivbkei hd tai fehdhfbe sfmri.
Jmrimvir, tai fehdhfbe sfmri wbs beribgy sm emw botir <.8%
sbehdi tabt dmdi mo tai hdobdts riquhrig amsphtbe bgjhsshmd
bdg fmueg ki sidt amji. Waus dm hjprmvijidt hd jmri
\ighbtrhf \uejmdmem`y
Aypirtmdhf Vbehdi 68
7/23/2019 Hypertonic Saline or High Volume Normal Saline for Viral Bronchiolitis
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hjpmrtbdt mutfmjis sufa bs b gifribsi mo tai rbti bdg
gurbthmd mo amsphtbehzbthmd bttrhkutbkei tm aypirtmdhf
sbehdi (Fmfarbdi rivhiw ;<<1) wbs gijmdstrbkei.
Hdgiig, 1 fj6 mo <.8% sbehdi hs dmt b pebfikm bs pmhdtig
mut ky Vmmg it be.7 wam samwig tabt tai fabd`i hd BVE
gipta bdg tairiomri, tai hjprmvijidt hd jufus feibrbdfi
botir dmrjbe sbehdi mr aypirtmdhf sbehdi hdabebthmds hs dmt boudfthmd mo tai sbehdi fmdfidtrbthmd kut rbtair b ghrift
risuet mo tai tmtbe jbss mo DbFe bggig tm tai bhrwby
surobfi.
Bgghthmdbeey, Vbrriee it be.27 samwig tabt jiriey ; fj6
mo dikuehzig 6% AV smeuthmd (µ<.<? ` mo DbFe) wbs
idmu`a tm hjprmvi FV hd riebthviey jheg bjkuebtmry
fahegrid whta vhrbe krmdfahmehths. Waisi hdobdts wiri
fmjpbrbkei hd sivirhty bdg b`i tm tai prisidt stugy
pmpuebthmd. Ih`at fukhf fidthjitirs mo <.8% sbehdi usig hd
tahs stugy bsb fmdtrme hs iqubes tm <.<0; ` mo DbFe wahfa hs
`ribtir tabdtabt usigky Vbrriee.Waus ht hs mkvhmus tabt tahs
gbtb fmueg dmt ki hdtirpritig bs hdghfbthd` bksidfi mo bdiooift mo aypirtmdhf sbehdi.21 Md tai fmdtrbry, tahs gbtb
fmueg mdey ki hdtirpritig, bs b pmshthvi iooift mo ah`a
vmeuji hdabebthmd mo dmrjbe sbehdi tabt giehvirig b jbss
mo DbFe suo flfhidt tm tribt hdobdts whta viry jheg vhrbe
krmdfahmehths.
Ourtairjmri shdfi tai prisidt stugy hdfeugig b tmtbe mo
21? pbthidts, bee mo wamj rifihvig bt eibst 0; j` mo DbFe
ht wbs, ah`aey pmwirig tm gitift b fehdhfbeey sh`dhflfbdt
kidiflt. Divirtaieiss, bs stbtig ky tai butamrs, bdg bgghd`
tai `ribt hjprmvijidt hd bee tai `rmups (dmtahd` ourtair
tm ki `bhdig), tai stugy hs dmt pmwirig tm gitift tai ebfc
mo b fehdhfbeey sh`dhflfbdt ghooiridfi kitwiid tai `rmups
(6? ‖68 hdobdts pir `rmup).
FMDFEYVHMDV
Dikuehzig 6% sbehdi samueg ki fmdshgirig bd iooifthvi
bdg sboi tribtjidt omr hdobdts whta vhrbe krmdfahmehths.
Ivid hd jhegey booiftig hdobdts ht hs prmkbkey obstir bdg
jmri fmdvidhidt tm usi b riebthviey sjbee vmeuji mo
DbFe bs aypirtmdhf sbehdi. @hvid tai rifidt mksirvbthmds
gisfrhkig bkmvi, b pmstuebtig jifabdhsj ixpebhdhd`
aypirtmdhf sbehdi hdabebthmd tribtjidt pbrthfuebrey hd
[V_ krmdfahmehths hs prisidtig. Ourtair stughis tm fmdflrj
mr ghsputi tahs aypmtaishs bri wbrrbdtig.
BFCDMPEIG@JIDWV
Pi tabdc Jhfabie W. Diwamusi JG omr ahs chdg
frhthfhsj bdg su``isthmds.
[IOI[IDFIV
2. Gmdbegsmd VA. Aygrbtmr tairbphis omr fysthf flkrmshs eud` ghsibsi.
\ighbtr \uejmdme ;<<1376>V21 ‖V;6.
;. [bdgiee VA, Kmufair [F. Iooifthvi jufus feibrbdfi hs issidthbe
omr risphrbtmry aibeta. Bj N [isphr Fiee Jme Khme ;<<?369>;<‖;1.
6. Kmm`brg [F, gi Nmd`sti N, Jircus \. \abrjbfmtairbpy mo
hjpbhrig jufmfhehbry feibrbdfi hd dmd-FO pighbtrhf eud` ghsibsi.
B rivhiw mo tai ehtirbturi. \ighbtr \uejmdme ;<<037;>818 ‖2<<2.
7. Vmmg D, Kidditt PG, ^ijbd C, Krmwd N, Omy F, Kmufair [F,
Cdmweis J[. Hdfribshd fmdfidtrbthmd mo hdabeig sbehdi whta
mr whtamut bjhemrhgi> iooift md jufmfhehbry feibrbdfi hd dmrjbe
suknifts. Bj N [isphr Frht Fbri Jig ;<<632?0>291 ‖2?6.
9. Gbvhscbs I, Bdgirsmd VG. Aypirmsjmebr b`idts bdg feibrbdfi mo jufus hd tai ghsibsig bhrwby. N Birmsme Jig ;<<?328>2<< ‖2<8.
?. Pbhdwrh at F, Betbjhrbdm E, Faidiy J, Faidiy N, Kbrkir
V, \rhfi G, Jmemdiy V, Chjkireiy B, Pmmeflieg D, Fbgzmw V,
Ohujbrb O, Phesmd \, Ji m V, _bdgi_iegi G, Vbdgirs V,
M‘[murci \, Orbdfhs \. B juethfidtir, rbdgmjhzig, gmukei-kehdg,
fmdtrmeeig trhbe mo dikuehzig iphdiparhdi hd hdobdts whta bfuti
krmdfahmehths. D Id`e N Jig ;<<63678>;0 ‖69.
0. \btie A, \ebtt [, Emzbdm NJ, Pbd` IIE. @eufmfmrthfmhgs omr
bfuti vhrbe krmdfahmehths hd hdobdts bdg ymud` fahegrid. Fmfarbdi
Gbtbkbsi Vyst [iv ;<<736>FG<<7101.
1. Gbrvheei W, Xbjbufah W. [isphrbtmry sydfythbe vhrus. \ighbtr [iv
2881328>99 ‖?2.
8. Wbrrbd [, @rukk K[, \brsmds G, \hfair J, Ahrsa BN, Gbvhs FP.
Kmufair Wai FO sbet fmdtrmvirsy> hd vhvm mksirvbthmds bdg
tairbpiuthf bpprmbfais. Jme Fiee ;<<231>278‖291.2<. Phees \N, Abee [E, Fabd P, Fmei \N. Vmghuj faemrhgi hdfribsis
tai fhehbry trbdspmrtbkhehty mo fysthf flkrmshs bdg krmdfahiftbshs
sputuj md tai jufus-gipeitig kmvhdi trbfaib. N Fehd Hdvist 28803
88>8‖26.
22. ^hjidt H. [isphrbtmry pabrjbfmem y bdg tairbpiuthfs. \ahebgie-
pahb> PK Vbudgirs3 2801.
2;. [mkhdsmd J, Aijjhd` BE, [i`dhs NB, Pmd` B@, Kbheiy GE,
Kbutmvhfa @N, Chd` J, Kyi \W. Iooift mo hdfribshd` gmsis mo
aypirtmdhf sbehdi md jufmfhehbry feibrbdfi hd pbthidts whta fysthf
flkrmshs. Wamrbx 288039;>8<<‖8<6.
26. Jbdgiekir` B, Wbe @, Phtzehd` J, Vmjifc I, Amurh V, Vbrriee J,
\rhie HI. Dikuehzig 6% aypirtmdhf sbehdi tribtjidt hd amsph-
tbehzig hdobdts whta vhrbe krmdfahmehths. Faist ;<<632;6>712‖
710.
27. Vbrriee IJ, Wbe @, Phtzehd` J, Vmjica I, Amurh V, Fmaid AB,Jbdgiekir B. Dikuehzig 6% aypirtmdhf sbehdi tribtjidt hd
bjkuebtmry fahegrid whta vhrbe krmdfahmehths gifribsis syjptmjs.
Faist ;<<;32;;>;29‖;;<.
29. Vjhta GP, Orbdcie E[, Jbtairs EA, Wbd` BW, Brhb dm [E,
\rmkir F@. B fmdtrmeeig trhbe mo birmsmehzig rhkbvhrhd hd hdobdts
rifihvhd` jifabdhfbe vidthebthmd omr siviri risphrbtmry sydfythbe
vhrus hdoifthmd. D Id`e N Jig 288236;9>;7 ‖;8.
2?. Wbe @, Fisbr C, Mrmd B, Amurh V, Kbeehd B, Jbdgiekir B.
Aypirtmdhf sbehdi/iphdiparhdi tribtjidt hd amsphtbehzig hdobdts
whta vhrbe krmdfahmehths rigufis amsphtbehzbthmd stby> ; yibrs
ixpirhidfi. Hsr Jig Bssmf N ;<<?31>2?8‖206.
20. Cuzhc KB, Be Rbgah VB, Cidt V, Oebvhd J\, Ampjbd P, Amtti V,
@bdgir V. Dikuehzig aypirtmdhf sbehdi hd tai tribtjidt mo vhrbe
krmdfahmehths hd hdobdts. N \ighbtr ;<<03292>;?? ‖;0<.
21. ^abd` E, Jidgmzb-Vbssh [B, Pbhdwrh`at F, Cebssid W\.Dikuehzig aypirtmdhf sbehdi smeuthmd omr bfuti krmdfahmehths hd
hdobdts. Fmfarbdi Gbtbkbsi Vyst [iv ;<<137> FG<<?791.
28. Bdhe BK, Bdhe J, Vb`ebj BK, Fithd D, Kbe B, Bcsu D. Dikuehzig
sbekutbjme, iphdiparhdi, 6% sbehdi bdg dmrjbe sbehdi bri iqubeey
iooifthvi hd jheg krmdfahmehths hd pighbtrhf ijir`idfy gipbrtjidt.
\ighbtrhf \uejmdmem`y ;<<8.
;<. Pbhdwrh at F, Betbjhrbdm E, Faidiy J, Faidiy N, Kbrkir
V, \rhfi G, Jmemdiy V, Chjkireiy B, Pmmeflieg D, Fbgzmw V,
Ohujbrb O, Phesmd \, Ji m V, _bdgi_iegi G, Vbdgirs V,
M‘[murci \, Orbdfhs \. B juethfidtir, rbdgmjhzig, gmukei-kehdg,
fmdtrmeeig trhbe mo dikuehzig iphdiparhdi hd hdobdts whta bfuti
krmdfahmehths. D Id`e N Jig ;<<6378>;0 ‖69.
\ighbtrhf \uejmdmem`y
7< Jbdgiekir` bdg Bjhrbv