A few key points to remember:
- Nebulized 3%NaCl to be used for children with bronchiolitis, ie. mainly < 2 years of age (no lower age limit)
- No contraindications
- While studies have used anywhere from 2-4 ml /nebulization, as there is no down side, I would recommend we all use 4 ml
- The theory is that it breaks up the thick mucous that is stuck in the bronchioles, therefore it has the ability to improve oxygen saturation, decreased work of breathing (both respiratory effort and RR), therefore you gauge efficacy based on any improvement in these parameters. There is no benefit to using it "back to back", it either works or doesn't. If it works you can use it again if whatever parameter that had improved before worsens again. Based on what I have read (as I do not have much personal experience with it), it seems that if it works, the mucous does not build back up to the previous level that quickly, and you probably won't be using it more often that every several hours (though you can, it is safe).
- There is a theoretical risk of it inducing bronchospasm, and the way you would detect this is your patient's respiratory status worsening after the treatment. While this is always sited as a theoretical risk, newer studies have shown that it is in fact not really that much of an issue clinically. Therefore, know it can happen, but don't worry about it too much. If you think you are seeing it frequently, you are probably overcalling something…
- Keep in mind the most compelling evidence is that it decreases length of admission, therefore we should be using it for patients who require admission, or who might require admission, but not in those patients who are well enough for discharge home.
