Uncertainty surrounds the most effective treatments for bronchiolitis, leading to significant variations in clinical practice across different healthcare settings. This study addresses this gap by providing a Comparative analysis of common interventions for bronchiolitis in children aged two years and under.
This research employed a network meta-analysis to evaluate the comparative effectiveness of various bronchiolitis treatments. Data was gathered from comprehensive searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform, spanning from inception up to September 1, 2019. The study selection process involved 150 randomized controlled trials. These trials featured comparative assessments of placebo or active comparators against bronchodilators, glucocorticoid steroids, hypertonic saline solution, antibiotics, helium-oxygen therapy, or high-flow oxygen therapy.
Data extraction was conducted and independently verified to ensure accuracy. The primary outcomes measured were admission rates on day 1 and by day 7, alongside hospital length of stay. The strength of evidence was rigorously evaluated utilizing the Confidence in Network Meta-Analysis methodology.
The results indicated that nebulized epinephrine (odds ratio: 0.64, 95% confidence interval [CI]: 0.44 to 0.93, low confidence) and nebulized hypertonic saline combined with salbutamol (odds ratio: 0.44, 95% CI: 0.23 to 0.84, low confidence) demonstrated a reduction in hospital admission rates on day 1. However, none of the treatments showed a significant reduction in admission rates by day 7. Regarding hospital length of stay, nebulized hypertonic saline (mean difference: -0.64 days, 95% CI: -1.01 to -0.26, low confidence) and nebulized hypertonic saline in conjunction with epinephrine (mean difference: -0.91 days, 95% CI: -1.14 to -0.40, low confidence) were found to shorten the duration of hospitalization.
A key limitation of this analysis is the absence of reported adverse events, precluding any conclusions regarding treatment safety. In conclusion, while hypertonic saline, either alone or in combination with epinephrine, may decrease hospital stay for infants, the low strength of evidence highlights the urgent need for further robust and rigorous trials to solidify these findings and ensure safe and effective comparative treatment strategies for bronchiolitis.
