Hypertonic saline nebulized treatments did not reduce hospitalization in children with bronchiolitis. Just use suction, supplemental oxygen as needed, and IV hydration in children who can't take liquids. Otherwise, there are not many good options.
Nebulized hot salts
Nebulized 3% saline for bronchiolitis has been used with varying success in the literature. An earlier meta-analysis showed benefit, but later studies have not shown benefit. This RCT of 777 kids with bronchiolitis compared NS vs 3% and found no difference in the primary outcome, hospitalization at 24 hours. More kids in the 3% group had cough without respiratory distress, but otherwise there was no increase in adverse outcomes. But that is the point of hypertonic saline - more coughing and clearing of secretions, right? Respiratory distress scores improved more in the 3% group. Although that's good, it isn't an important patient-centered outcome like hospital admission.
The Skeptics Guide to EM covered a similar article last year. See their take on it.
Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr. 2017 Jun 5:e171333. doi: 10.1001/jamapediatrics.2017.1333. [Epub ahead of print]
Peer reviewed by Thomas Davis.