Nebulized Hypertonic Saline for Mechanically Ventilated Children
| Status: | Completed |
|---|---|
| Conditions: | Pulmonary |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any - 18 |
| Updated: | 2/7/2015 |
| Start Date: | October 2013 |
| End Date: | January 2014 |
Children who need to be on a ventilator often have thick secretions/mucus in their lungs.
These secretions can obstruct the breathing tube and their windpipe, which can worsen lung
function and prolong the need for the ventilator. Hypertonic saline is a medicine that is
used to thin out secretions in patients with cystic fibrosis (and other conditions). We
hypothesize that having children on a ventilator inhale this medication will shorten the
amount of time that they need to be on the ventilator.
These secretions can obstruct the breathing tube and their windpipe, which can worsen lung
function and prolong the need for the ventilator. Hypertonic saline is a medicine that is
used to thin out secretions in patients with cystic fibrosis (and other conditions). We
hypothesize that having children on a ventilator inhale this medication will shorten the
amount of time that they need to be on the ventilator.
Recent pediatric data shows that less than 80% of children mechanically ventilated for ≥ 96
hours survived to PICU discharge, while 100% of children mechanically ventilated for < 96
hours survived to PICU discharge. Interventions that decrease duration of mechanical
ventilation may improve outcome by limiting ventilator-induced lung injury, sedative
medication usage and ventilator-associated pneumonia. Obstructive airway secretions may
prolong mechanical ventilation by causing atelectasis and endotracheal tube obstruction,
with resultant cardio-respiratory instability. Nebulized hypertonic saline (HTS) is used to
decrease mucus viscosity and increase mucociliary clearance in patients with diseases such
as cystic fibrosis and bronchiolitis, and has been used to enhance airway clearance in
mechanically ventilated children. Administering nebulized HTS to mechanically ventilated
children may facilitate airway clearance and shorten mechanical ventilation.
In a randomized study of children < 2 years old following cardiac surgery, patients given
dornase, another mucolytic agent, had a significantly decreased duration of mechanical
ventilation versus those given saline placebo (52 hrs vs. 82 hrs). HTS may be even more
effective, as mechanically ventilated newborns with persistent atelectasis had more
improvement in radiographic findings and oxygen saturation when randomized to receive
hypertonic saline compared to those randomized to receive dornase. This may be because
dornase may only be effective in patients with leukocytes or bacterial present in tracheal
aspirates, while HTS may be effective in all ventilated patients. Further study of the
impact of prophylactic mucolytic therapy on the duration of mechanical ventilation in
children is warranted.
hours survived to PICU discharge, while 100% of children mechanically ventilated for < 96
hours survived to PICU discharge. Interventions that decrease duration of mechanical
ventilation may improve outcome by limiting ventilator-induced lung injury, sedative
medication usage and ventilator-associated pneumonia. Obstructive airway secretions may
prolong mechanical ventilation by causing atelectasis and endotracheal tube obstruction,
with resultant cardio-respiratory instability. Nebulized hypertonic saline (HTS) is used to
decrease mucus viscosity and increase mucociliary clearance in patients with diseases such
as cystic fibrosis and bronchiolitis, and has been used to enhance airway clearance in
mechanically ventilated children. Administering nebulized HTS to mechanically ventilated
children may facilitate airway clearance and shorten mechanical ventilation.
In a randomized study of children < 2 years old following cardiac surgery, patients given
dornase, another mucolytic agent, had a significantly decreased duration of mechanical
ventilation versus those given saline placebo (52 hrs vs. 82 hrs). HTS may be even more
effective, as mechanically ventilated newborns with persistent atelectasis had more
improvement in radiographic findings and oxygen saturation when randomized to receive
hypertonic saline compared to those randomized to receive dornase. This may be because
dornase may only be effective in patients with leukocytes or bacterial present in tracheal
aspirates, while HTS may be effective in all ventilated patients. Further study of the
impact of prophylactic mucolytic therapy on the duration of mechanical ventilation in
children is warranted.
Inclusion Criteria:
- invasive mechanical ventilation of < 12 hrs duration prior to enrollment
- expected duration of mechanical ventilation of > 48hrs from enrollment
- age < 18yo
Exclusion Criteria:
- inclusion in another clinical study
- cystic fibrosis
- status asthmaticus
- pulmonary hemorrhage/contusion
- home O2 use
- home non-invasive positive pressure (CPAP/BiPAP) ventilation use
- pre-existing tracheostomy
- prescription of mucolytic medication by primary clinical team
- allergy to inhaled saline/hypertonic saline or albuterol
We found this trial at
1
site
Cleveland, Ohio 44106
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