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Outpatient Hypertonic Saline

Bronchiolitis team recommendation: We concur with the Clinical Practice Guideline of AAP that makes a moderate recommendation that 3% nebulized hypertonic saline should not be administered to infants and children in the Emergency Department, and further makes a weak recommendation that 3% nebulized hypertonic saline may be administered to infants and children who are in the hospital (Ralston et al., 2014). Further research is likely to have an important influence on our confidence in these recommendations.

Literature (See Appendix A) supporting this recommendation: Twenty citations are included to answer this question. Sixteen are blinded RCT, and four are open label RCT. All studies included in the AAP Guideline (Ralston et al. 2014) and studies published after the AAP Guideline literature search are included.

Critically Appraised Topic (CAT): Hypertonic Saline

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.