hypertonic saline or high volume normal saline for viral bronchiolitis

7/23/2019 Hypertonic Saline or High Volume Normal Saline for Viral Bronchiolitis

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\ighbtrhf \uejmdmem`y 79>6?‖7< (;<2<)

Hdvhtig Fmjjidtbry

Aypirtmdhf Vbehdi mr Ahà _meuji Dmrjbe Vbehdi omr_hrbe Krmdfahmehths> Jifabdhsjs bdg [bthmdbei

Bvh`gmr Jbdgiekir`, JG2* bdg Hsrbie Bjhrbv, JG

;

Ciy wmrgs> aypirtmdhf sbehdi3 vhrbe krmdfahmehths3 [V_3 jufus feibrbdfi3 k; b`mdhst3

dmrjbe sbehdi.

HDW[MGYFWHMD

Hd rifidt yibrs bdg pbrthfuebrey hd tai ebst 9 yibrs, tairi

abvi kiid sukstbdthbe bgvbdfis hd mur udgirstbdghd` mo tai

jifabdhsjs `mvirdhd` jufus feibrbdfi (JF) hd aibeta

bdg ghsibsi. Waisi abvi gijmdstrbtig tai rmei mo

aygrbthmd mo tai bhrwby surobfi ehquhg (BVE) bdg tai

hjpmrtbdfi mo hdabeig aypirtmdhf sbehdi omr riaybgrbthmd

bdg abvi kiid rifidtey rivhiwig.2‖ 6

Krhiy, ht wbs su`ìstig tabt JF obheuri hs b gmjhdbdt

obftmr dmt mdey hd FO kut hd jmst bhrwby ghsibsis bdg tabt

aygrbthmd hs tai gmjhdbdt vbrhbkei `mvirdhd` JF hd bee

bhrwby ghsibsis.;,6

Wahs wbs besm omudg tm ki trui ividhd dmrjbe suknifts7 bdg ourtairjmri, ht abs kiid dmtig,

tabt ixbfirkbthmds hd jbdy bhrwby ghsibsis risuet ormj

hdtirjhttidt fbtbstrmpahf obheuris mo JF gui tm giaygrb-

thmd mo BVE motid trh`ìrig ky vhrbe hdoifthmds. Waus,

tairbpy tm jbhdtbhd BVE aygrbthmd hs prmkbkey hjpmrtbdt

gurhd` vhrbe ixbfirkbthmds dmt mdey hd FO pbthidts kut hd bee

farmdhf bhrwby ghsibsis.;,9

Hssuis frufhbe tm udgirstbdghd` tai pmstuebtig jifab-

dhsj hdvmevhd` aypirtmdhf sbehdi hdabebthmd tribtjidt hd

[V_ krmdfahmehths whee ki gisfrhkig hd jmri gitbhe airi.

\MVVHKEI JIFABDHVJV MO BVE GIAXG[BWHMD

HD _H[BE K[MDFAHMEHWHV

Ioflfhidt feibrbdfi riquhris tai fmmrghdbtig hdtirbfthmd

mo twm sipbrbti ebyirs> bd mvireyhd` trbdspmrtig jufus

ebyir (JE) bdg b sipbrbti, ghsthdft idvhrmdjidt dibr

tai fiee surobfi fbeeig pirhfhehbry ehquhg (\FE). BVE

fmjprhsis kmta mo taisi ebyirs.; Ohùri 2 hs b sfaijbthf

riprisidtbthmd mo tai prmpmsig jifabdhsjs mo BVE

giaygrbthmd hd [V_ krmdfahmehths (Oh`. 2K,F) fmjpbrig

tm dmrjbes (Oh`. 2B) bdg FO pbthidts (Oh`. 2G). Vhdfi

bhrwby iphtaiehb bri wbtir pirjibkei, wbtir jmvis tm

iqubehzi ieiftrmeyti fmdfidtrbthmds omeemwhd` hdwbrg

bfthvi bksmrpthmd mo Db tarmuà IDbF tairiky fbushd`

giaygrbthmd mo tai BVE bdg mutwbrg omeemwhd` Fe

trbdspmrt tarmuà kmta FOW[ bdg Fbefhuj bfthvbtig

faemrhgi fabddies (FbFF), taus aygrbthd` tai BVE.

Ky bfthvbthd` tai B;1 rifiptmr (rig), bgidmshdi

sthjuebtis tai FOW[ tm sifriti Fe bdg tm bttidubti IDbF

bfthvhty, taus aygrbthd` tai BVE. Hd vhvm, BW\ bfthvbtis tai

\;X; rifiptmr (keui) taus sthjuebthd` FbFF tm sifriti Fe

bdg ghriftey bttidubti IDbF bfthmd, taus aygrbthd` tai

BVE. BW\, wahfa ribfais mdey di eh`hkei, hdiooifthvi

fmdfidtrbthmds hd stbthf thssui fueturis, ribfais b ahà

fmdfidtrbthmd hd vhvm (hd jmvhd` eud`s) bdg hs prmkbkey

tai jmst hjpmrtbdt aygrbthd` bdg fmjpidsbthd` sthjueusomr riùebthd` tai BVE wbtir fmdtidt.; Wahs hdfribsi hd

BW\ fmdfidtrbthmd, tabt mffurs mdey hd vhvm, hs gui tm

b jifabdhsj fbeeig jifabdmtrbdsgufthmd hd wahfa fiees

fmdvirt b jifabdhfbe sthjueus hdtm faijhfbe bfthvhty.

Hd tahs fbsi, tai pabshf jmthmd mo tai bhrwby mw

(eud` hdbthmd/gibthmd bdg pbrthfuebrey bffieirbthmd

bdg gifieirbthmd) prmgufis b saibr striss wahfa hs

2Wai \ighbtrhf \uejmdbry Ydht, Wai Ighta Pmeosmd Jighfbe Fidtir

(Boflehbtig whta Wai Vbfceir Vfamme mo Jighfhdi, Wie Bvhv Ydhvirshty,

Hsrbie), Amemd, Hsrbie

;Wai \ighbtrhf Gipbrtjidt, [. Vhioo Amsphtbe, Vboig, Hsrbie (Boflehbtig whta

tai Wifadhmd Vfamme mo Jighfhdi Abhob, Hsrbie2)

*Fmrrispmdgidfi tm> Bvh`gmr Jbdgiekir`, Ghriftmr, \ighbtrhf \uejmdbry

Ydht, Wai Gipbrtjidt mo \uejmdbry Jighfhdi bdg \ighbtrhfs, Wai Ighta

Pmeosmd Jighfbe Fidtir, ?;, Abemfabjhj Vtriit, Amemd 912<<, Hsrbie.

I-jbhe> bvh`gmrjLditvhshmd.dit.he

[ifihvig 2 Nudi ;<<83 [ivhsig 8 Buùst ;<<83 Bffiptig 2; Buùst ;<<8.

GMH 2<.2<<;/ppue.;2219

\ukehsaig mdehdi 1 Gifijkir ;<<8 hd Pheiy HdtirVfhidfi

(www.hdtirsfhidfi.wheiy.fmj).

;<<8 Pheiy-Ehss, Hdf.



tbdìdthbe tm tai bphfbe iphtaiehbe fiee jijkrbdi (hd

fmdtrbst tm tai dmrjbe striss tabt hs pirpidghfuebr) bdg

fbusis tai iphtaiehbe fiee tm rieibsi ixtrb-fieeuebr BW\ taus

aygrbthd` tai BVE (Oh`. 2B). Wahs ebttir jifabdhsj abskiid samwd tm ki ahàey vuedirbkei tm vhrbe hdnury

pbrthfuebrey bs mffurs hd [V_ hdoifthmds.;

Jbhdtbhdhd` dmrjbe aihàt mo tai \FE (brmudg 0jj) hs

frufhbe omr jbhdtbhdhd` dmrjbe bhrwby jufmfhehbry

feibrbdfi (JFF) sm tabt tai jmvhd` thps mo tai fhehb

whee prifhsiey fmdtbft tai emwir jbr`hd mo tai JE. Wahs

hs jbhdtbhdig ky tai JE bfthd` bs b wbtir risirvmhr

sieifthviey bksmrkhd` wbtir hd rispmdsi tm ixfiss aygrb-

thmd bdg hdfribshd` tai JFF tm supir-dmrjbe rbtis

(Oh . 2B). Wahs supir-dmrjbe JFF wbs gijmdstrbtig

hd dmrjbe suknifts wam hdabeig aypirtmdhf sbehdi (AV)

birmsmes.7

Hd fmdtrbst, ht hs su`ìstig tabt waid giay-grbthmd mo tai BVE mffurs hd rispmdsi tm b riebthviey jheg

[V_ hdoifthmd, ixtrb-fieeuebr BW\ fmdfidtrbthmds bri

gipeitig, taus giaygrbthd` tai BVE. Wai JE taid gmdbtis

wbtir tm prisirvi bt eibst smji JF wahei jbhdtbhdhd` tai

\FE aihàt femsi tm tai dmrjbe bpprmxhjbtiey 0 jj bdg

risuethd` hd JE giaygrbthmd (; bdg Oh`. 2K). Amwivir,

waid tahs gmdmr jifabdhsj hs ixabustig, tai JE abs dmjmri wbtir tm gmdbti, tai \FE jby stbrt tm fmdtrbft tm tai

pmhdt tabt JFF hs hjpmsshkei (Oh . 2F). Bs FO iphtaiehuj,

wahfa ebfcs FOW[ (Oh`. 2G), hs taus tmtbeey gipidgidt md

BW\, tai \FE fmdtrbfthmd mffurs ibrey, ivid hd FO bhrwbys

ixpmsig tm riebthviey jhdmr vhrbe hdnury hd FO ixbfir-

kbthmds (; bdg Oh`. 2G).

Hd sjbee kbkhis suooirhd` ormj siviri bfuti [V_

krmdfahmehths, tai ahà embg mo [V_ hdoifthmd hd tai sjbee

krmdfahmeis, prmkbkey fbusis b fmdshgirbkei rigufthmd mo

ixtrb fieeuebr BW\ tabt hs frufhbe omr jbhdtbhdhd` BVE

aygrbthmd hd vhvm. Hd bgghthmd, tai dmd-spifhflf pbtamem`-

hfbe hjpbft mo [V_ hdoifthmd sufa bs tai fytmtmxhf iooiftsmd fiees, fhehbry gbjbì bdg fytmchdi rieibsi risuets hd

jufus peu``hd` mo sjbeeir bhrwbys. Pi aypmtaishzi tabt

tai prmtifthvi iooifts mo tai JE risirvmhr bdg tabt mo tai

sthee oudfthmdhd` FOW[ hd tai rijbhdhd` iphtaiehbe fiees

tabt wiri dmt jbsshviey gbjb ig ky tahs [V_ hdbjjb-

thmd, hs prmkbkey ixfiigig, taus gipeithd` dmt mdey tai

jufus ebyir wbtir fmdtidt kut besm gbjb`hd` tai BVE

iphtaiehbe brfahtifturi taus rigufhd` tai aih at, mo tai \FE

bdg hjpbhrhd` JF. Wahs ehciey fmdtrhkutis tm bhrwby

jufus peu``hd`, bhrwby mkstrufthmd, aypirhdbthmd bdg

btieiftbshs tabt besm fabrbftirhzi siviri [V_ hdoifthmd.

BKK[I_HBWHMDV

BVE Bhrwby surobfi ehquhg

\FE \irhfhehbry ehquhg

JE Jufus ebyir

JF Jufus feibrbdfi

JFF Jufmfhehbry feibrbdfi

FV Fehdhfbe sfmri

\ighbtrhf \uejmdmem`y

Oh`. 2. \mstuebtig jifabdhsj hd vhvm, ixpebhdhd` BVE giaygrbthmd hd [V_ krmdfahmehths bs

fmjpbrig tm dmrjbe bdg FO>(B) dmrjbe,(K) jheg [V_ krmdfahmehths> (F) siviri [V_ krmdfahmehths,

(G)gurhd` vhrbehdoifthmd hd FO. Wahsflùri wbsjmghflig pbrthfuebrey omr [V_ krmdfahmehths, whtatai

pirjhsshmd bdg tai fmurtisy mo [bdgiee VA bdg Gmdbegsmd VA, kmta ormjtai Ydhvirshty mo Dmrta

Fbrmehdb bt Fabpie Ahee.

Aypirtmdhf Vbehdi 60



Amwivir, betamuà obhrey ribsmdbkei bs b wby mo ixpebhd-

hd` tai mksirvbthmds, tahs ebttir aypmtaishs abs divir kiid

prmvid hd b prmpirey gish`dig pebfikm-fmdtrmeeig stugy

riifthd` tai fmjpeix hdtirbfthmds tabt mffur hd vhvm, hd

tai vbrhmus krmdfahbe bdg krmdfahmebr bhrwbys hd sjbee

kbkhis gurhd` tai ivmeuthmd mo dbturbeey mffurrhd` bfuti

[V_ krmdfahmehths. Wamuà giaygrbthmd mo tai BVEbdg JF gysoudfthmd udgmuktigey mffur, bt prisidt wi

gm dmt cdmw tm wabt ixtidt. Pi fbd mdey prisuji tabt,

bt smji stbì, bdg hd smji krmdfahmeis mo taisi jmri

siviriey booiftig kbkhis, tai hjpbft mo [V_ hdoifthmd md

tai BVE hs prmkbkey hdtirjighbti kitwiid Ohùri 2K bdg

G bdg kitwiid udhdoiftig dmrjbe BVE bdg tai viry

ixtriji fmdghthmds tabt mffur hd vhrbe hdoiftig FO BVE

(Oh`. 2B‖ G).

[BWHMDBEI MO AV BI[MVME W[IBWJIDW

HD [V_ K[MDFAHMEHWHV

Hdobdts whta bfuti vhrbe krmdfahmehths waiizi kut bs tai

pbtampayshmem`y mo krmdfahmehths hs quhti ghsthdft ormj

tabt mo bstajb, taisi hdobdts bri eiss ho bt bee rispmdshvi

tm krmdfamghebtmrs? mr stirmhgs.0 Krmdfahmehths hs b vhrbe

hdoifthmd mo tai krmdfahbe bdg krmdfahmebr iphtaiehuj,

whta suksiquidt pirhkrmdfahmebr jmdmdufeibr hdfletrbthmd

bdg iphtaiehbe fiee difrmshs, prmomudg suk-jufmsbe igijb,

hdfribsig sifrithmd mo jufus bdg tairiomri bd hdfribsi

hd jufhd/wbtir rbthm1 tabt fbusis riebthvi giaygrbthmd mo

BVE.; Jmrimvir, [V_, ky hdfribshd` BW\bsi eivies

gifribsis ixtrb fieeuebr BW\ bdg tairiomri risuets hd emss

mo IDbF hdahkhthmd (hdfribshd` Db bksmrpthmd) bdg emss mo tai bttidubthmd mo mutwbrg sifrithmd mo faemrhgi. Waus,

jmri wbtir whee jmvi ormj tai BVE tm tai suk-jufmsb

bemd` whta taisi ieiftrmeytis (Oh`. 2K,F). Wahs whee risuet

hd jmri giaygrbthmd mo tai BVE, bdg b gifribsi hd tai

aihàt mo tai jufus ebyir (Oh`s. 2K bdg ;). Waus

aypmtahfbeey, hd jmri siviriey booiftig krmdfahmebr bribs,

tai BVE prmtifthvi aygrbthd` jifabdhsj fbd ki hjpbhrig

taus gipeithd` dmt mdey tai jufus ebyir‘s wbtir fmdtidt kut

besm gbjb`hd` tai BVE, bdg iphtaiehbe brfahtifturi wahei

tai gipeitig aihàt mo tai \FE hjpbhrs JF (Oh`. 2F).

Waus, bpprmprhbti tairbpy just aygrbti tai BVE, gifribsitai suk-jufmsbe igijb bdg hjprmvi tai jufus raimem`hf

prmpirthis (iebsthfhty bdg vhsfmshty) bdg taus hjprmvi JF.

Aypirtmdhf sbehdi jby, hd taimry, rivirsi smji mo taisi

pbtampayshmem`hfbe bkdmrjbehthis hd bfuti vhrbe krmdfahm-

ehths. Hd vhtrm, tai bgghthmd mo aypirtmdhf sbehdi hdfribsis

bhrwby surobfi tahfcdiss, gifribsis iphtaiehbe igijb,8

hjprmvis jufus raimem`hf prmpirthis (iebsthfhty bdg

vhsfmshty), bdg bffieirbtis jufus trbdspmrt rbtis.8,2<

Hd vhvm, aypirtmdhf sbehdi hdabebthmd hdfribsis tai rbti

mo jufmfhehbry trbdspmrt ivid hd dmrjbe suknifts whta

dm ivhgidfi mo giaygrbthmd, jufus aypir-sifrithmd mr

suk-iphtaiehbe igijb.

7

Bgghthmdbe Hjpmrtbdt Jmgis mo Bfthmd moBirmsmehzig AV Wribtjidts hd [V_ Krmdfahmehths

Pairibs aygrbthmd mo tai BVE hs fmdshgirig tai jbhd

jmgi mo bfthmd, bgghthmdbe hjpmrtbdt jifabdhsjs bri

bttrhkutig tm tai iooift mo AV ky wahfa AV hjprmvis JF

ky fhehbry mr fmuà bfthmds. Aypirtmdhf sbehdi kribcs tai

hmdhf kmdgs whtahd tai jufus ìe. Wahs, hd turd, rigufis tai

gi`rii mo frmss-ehdchd` bdg idtbdèijidts,22 taus hjprmv-

hd` jufus raimem`y. AV hdfribsis fhehbry kibt oriquidfy

vhb tai rieibsi mo prmstbèbdghd I;.9 Bgghthmd mo aypir-tmdhf sbehdi rbhsis tai hmdhf fmdfidtrbthmd hd tai jufus bdg

krhd`s bkmut b fmdomrjbthmdbe fabdì ky ‑‑sahieghd`‘‘ tai

di`bthvi fabrìs, tairiky rigufhd` ripueshmd. Wahs risuets

hd b jmri fmjpbft jufus jbfrmjmeifuei, bdg jmri


Oh`. ;. Vhjpehflig sfaiji bssujhd` mdey msjmthf omrfis tm fmdtrme wbtir trbdspmrt.

61 Jbdgiekir` bdg Bjhrbv



iooifthvi fmuà-gipidgidt JF.2; Bhrwby surobfi ehquhg

aypirmsjmebrhty fbd rieibsi jighbtmrs fbpbkei mo idabdf-

hd` fhehbry bfthvhty.9 Jmrimvir, ky bksmrkhd` wbtir ormj

tai jufmsb bdg suk-jufmsb, aypirtmdhf sbehdi smeuthmd

fbd taimrithfbeey rigufi igijb mo tai bhrwby wbee hd

hdobdts whta bfuti krmdfahmehths (26,27 bdg Oh`. ;). Aypir-

tmdhf sbehdi hdabebthmd fbd besm fbusi sputuj hdgufthmdbdg fmuà, wahfa fbd aiep tm feibr tai sputuj ormj tai

bhrwbys bdg taus hjprmvi bhrwby mkstrufthmd.26

FEHDHFBE VWYGHIV YVHD@ _B[HMYV DbFeFMDFIDW[BWHMDV BDG GMVIV HD[V_ K[MDFAHMEHWHV

Ghstheeig Pbtir (<% DbFe)

Vjhta it be.29 usig ghstheeig wbtir (<% DbFe) bs b

‑‑pebfikm‘‘ bdg gijmdstrbtig tabt birmsmehzig rhkbvhrhd

fmdshgirbkey rigufig tai gurbthmd mo jifabdhfbe vidtheb-thmd bdg amsphtbehzbthmd fmjpbrig tm ‑‑pebfikm‘‘ hd hdobdts

whta bfuti [V_ krmdfahmehths. Mkvhmusey, ht wbs dmt tai

rhkbvhrhd tabt hjprmvig tai tribtjidt `rmup kut tai

bgvirsi iooift mo tai ghstheeig wbtir tabt abg bd bgvirsi

iooift md tai ‑‑pebfikm‘‘ `rmup (Oh`. 2). Wai ‑‑kidiflfhbe‘‘

iooift mo rhkbvhrhd fmueg dmt ki gupehfbtig suksiquidtey hd

privhmusey aibetay hdobdts whta [V_ krmdfahmehths bdg

mdey taid wbs ht bpprifhbtig tabt ghstheeig wbtir wbs dmt bd

bpprmprhbti pebfikm bdg tai BB\ fabdìg hts privhmus

stbtijidt ormj ‑‑rhkbvhrhd samueg ki usig‘‘ tm ‑‑rhkbvhrhd

jby mdey ki fmdshgirig omr fahegrid whta sirhmus udgir-

eyhd` ghsmrgirs.‘‘1 Wahs hs rieivbdt tm mur tmphf hd twm

rispifts. Ohrstey, tahs tibfais us tabt wi samueg dmt bffiptwhtamut quisthmd b ‑‑pebfikm iooift‘‘ ivid waid piir

rivhiwig ky b riputbkei nmurdbe.29 Ohdbeey, ho ghstheeig

wbtir hs dmt bpprmprhbti, ht bppibrs tabt tairi hs dm ribeey

bgiqubti pebfikm omr AV stughis. Wahs samueg ki tbcid hdtm

bffmudt hd tai gish`d mo outuri stughis.

Aypirtmdhf Vbehdi (6%)

Hd tarii rbdgmjhzig gmukei kehdg pebfikm fmdtrmeeig

stughis Jbdgiekir it be.,26

Vbrriee it be.,27

bdg Wbe it be.2?

fmdflrjig tai io flfbfy mo AV hjprmvhd` tai gurbthmd mo

amsphtbehzbthmd bdg fehdhfbe sfmris, kmta hd bjkuebtmrybdgamsphtbehzig hdobdts whta [V_ krmdfahmehths. Amwivir bs

stbtig hd b Nuey ;<<0 rivhiw,6 taisi stughis wiri bee

fmdguftig ky tai sbji risibrfa `rmup bdg betamuà

prmjhshd` diigig tm ki fmdflrjig ky mtairs hd b jueth-

fidtir trhbe. Vhdfi taid, Cuzhc it be.20 pukehsaig b

prmspifthvi, rbdgmjhzig, gmukei-kehdg, pebfikm fmd-

trmeeig, jueth-fidtir trhbe (tarii fidtirs omr 6 yibrs) bdg

fmdflrjig tai ibrehir risuets. Hd ebti ;<<1, âbd` it be.21

pukehsaig b Fmfarbdi Gbtbkbsi [ivhiw tm sujjbrhzi tai

iooift mo dikuehzig AV hd taisi pbthidts. Ahs rivhiw

hdfeugig omur gmukei kehdg rbdgmjhzig trhbes hdvmevhd`

;97 hdobdts. Bdbeyshs mo tai pmmeig gbtb, su`ìstig tabt

tairbpy whta dikuehzig6% sbehdi sh`dhflfbdtey rigufig tai

gurbthmd mo amsphtbehzbthmd bdg hjprmvig tai fehdhfbe

sivirhty sfmri hd hdobdts whta bfuti vhrbe krmdfahmehths. Wai

hjpehfbthmds omr prbfthfi mo tahs rivhiw wiri tabt, `hvid

tai fehdhfbeey rieivbdt kidiflt bdg `mmg sboity prmflei,

dikuehzig 6% sbehdi usig hd fmdnudfthmd whta krmdfamgh-ebtmrs samueg ki fmdshgirig bd iooifthvi bdg sboi tribtjidt

omr hdobdts whta vhrbe krmdfahmehths.

Ahà _meuji Dmrjbe Vbehdi (<.8%)

Hd tahs hssui mo tai nmurdbe, Bdhe it be.28 pukehsaig b

rbdgmjhzig gmukei kehdg pebfikm fmdtrmeeig stugy tm

hdvisth`bti tai iooifthvidiss mo dikuehzig sbekutbjme,

iphdiparhdi bdg 6% sbehdi fmjpbrig tm ahà vmeuji

dmrjbe sbehdi hd tai tribtjidt mo bfuti jheg vhrbe

krmdfahmehths. Bee omur `rmups rifihvig twm hdabebthmds

mo tai tribtjidt gru`s hd tai ijirìdfy gipbrtjidt (thji< bdg 6< jhd). Waiy samwig tabt FV sfmris botir 6<, ?<,

bdg 2;< jhd wiri sh`dhflfbdtey bdg prm`risshviey kittir

tabd tai kbsiehdi vbeuis. Dm dikuehzig tairbpy mpthmds

hdfeughd` 6% sbehdi wiri jmri iooifthvi tabd mtairs.

Amwivir, bee tribtjidt jmgbehthis hdfeugig ahà gmsi

DbFe ghssmevig hd 1 je (0; j` omr tai sbekutbjme,

iphdiparhdi bdg dmrjbe sbehdi `rmups bdg ;7< j` omr

tai 6% sbehdi `rmup).

Hd vhiw mo rifidt di`bthvi risuets mo kitb b`mdhst

tribtjidt hd hdobdts whta krmdfahmehths,;; tai jbhd bggig

vbeui mo tahs stugy tm tai furridt ehtirbturi jby ki tabt

b ebrì jbss mo DbFe giehvirig bs ahà vmeuji dmrjbe

sbehdi hdabebthmds fmueg ki suo flfhidt tm fbusi sh`dhflfbdthjprmvijidt hd jheg bfuti vhrbe krmdfahmehths.

Amwivir, Bdhe‘s stugy samueg dmt ki hdtirpritig bs

fmdflrjbthmd omr b di`bthvi iooift mo aypirtmdhf sbehdi

hdabebthmdhd bfuti vhrbe krmdfahmehthsbdg wbs dmt hdfeugig

hd tai stughis bssijkeig tm ivbeubti tai hdabeig AV iooift

omr tai omeemwhd` ribsmds> Wahs hs b stugy mo viry jheg

krmdfahmehths tabt hjprmvig fmdshgirbkey bdg rbphgey

(hd 2;< jhd) botir mdey twm hdabebthmds mo 1 je <.8%

DbFe `hvid hd tai ijirìdfy gipbrtjidt. Wai tribtjidt

fmdshstig mo b shdèi gmsi hd fmdtrbst tm tai bkmvi

jidthmdig stughis tabt fmdthduig omr 6 ‖? gbys.21 Wai

hjprmvijidt wbs sm grbjbthf tabt bee mo taisi fahegridfmueg ki ghsfabrìg amji whtahd ; ar waid tai FV abg

hjprmvig ormj 6.? 2tm2.1 2.7. Wai M; sbturbthmd bdg

puesi rbti wiri dmrjbe ormj tai stbrt.

Fmdshgirhd` tahs bdg tai obft tabt <.8% sbehdi hs dmt b

pebfikm (7 bdg Oh`. ;), ht hs ivhgidt tabt, hd fmdtrbst tm tai

rifidt ehtirbturi, aypirtmdhf 6% sbehdi wbs ‑‑dmt jmri

iooifthvi‘‘ tabd <.8% sbehdi. Mkvhmusey, tairi wbs dm

ourtair hjprmvijidt bfahivbkei hd tai fehdhfbe sfmri.

Jmrimvir, tai fehdhfbe sfmri wbs beribgy sm emw botir <.8%

sbehdi tabt dmdi mo tai hdobdts riquhrig amsphtbe bgjhsshmd

bdg fmueg ki sidt amji. Waus dm hjprmvijidt hd jmri


Aypirtmdhf Vbehdi 68



hjpmrtbdt mutfmjis sufa bs b gifribsi mo tai rbti bdg

gurbthmd mo amsphtbehzbthmd bttrhkutbkei tm aypirtmdhf

sbehdi (Fmfarbdi rivhiw ;<<1) wbs gijmdstrbkei.

Hdgiig, 1 fj6 mo <.8% sbehdi hs dmt b pebfikm bs pmhdtig

mut ky Vmmg it be.7 wam samwig tabt tai fabdì hd BVE

gipta bdg tairiomri, tai hjprmvijidt hd jufus feibrbdfi

botir dmrjbe sbehdi mr aypirtmdhf sbehdi hdabebthmds hs dmt boudfthmd mo tai sbehdi fmdfidtrbthmd kut rbtair b ghrift

risuet mo tai tmtbe jbss mo DbFe bggig tm tai bhrwby

surobfi.

Bgghthmdbeey, Vbrriee it be.27 samwig tabt jiriey ; fj6

mo dikuehzig 6% AV smeuthmd (µ<.<? ` mo DbFe) wbs

idmuà tm hjprmvi FV hd riebthviey jheg bjkuebtmry

fahegrid whta vhrbe krmdfahmehths. Waisi hdobdts wiri

fmjpbrbkei hd sivirhty bdg bì tm tai prisidt stugy

pmpuebthmd. Ihàt fukhf fidthjitirs mo <.8% sbehdi usig hd

tahs stugy bsb fmdtrme hs iqubes tm <.<0; ` mo DbFe wahfa hs

`ribtir tabdtabt usigky Vbrriee.Waus ht hs mkvhmus tabt tahs

gbtb fmueg dmt ki hdtirpritig bs hdghfbthd` bksidfi mo bdiooift mo aypirtmdhf sbehdi.21 Md tai fmdtrbry, tahs gbtb

fmueg mdey ki hdtirpritig, bs b pmshthvi iooift mo ahà

vmeuji hdabebthmd mo dmrjbe sbehdi tabt giehvirig b jbss

mo DbFe suo flfhidt tm tribt hdobdts whta viry jheg vhrbe

krmdfahmehths.

Ourtairjmri shdfi tai prisidt stugy hdfeugig b tmtbe mo

21? pbthidts, bee mo wamj rifihvig bt eibst 0; j` mo DbFe

ht wbs, ahàey pmwirig tm gitift b fehdhfbeey sh`dhflfbdt

kidiflt. Divirtaieiss, bs stbtig ky tai butamrs, bdg bgghd`

tai `ribt hjprmvijidt hd bee tai `rmups (dmtahd` ourtair

tm ki `bhdig), tai stugy hs dmt pmwirig tm gitift tai ebfc

mo b fehdhfbeey sh`dhflfbdt ghooiridfi kitwiid tai `rmups

(6? ‖68 hdobdts pir `rmup).

FMDFEYVHMDV

Dikuehzig 6% sbehdi samueg ki fmdshgirig bd iooifthvi

bdg sboi tribtjidt omr hdobdts whta vhrbe krmdfahmehths.

Ivid hd jhegey booiftig hdobdts ht hs prmkbkey obstir bdg

jmri fmdvidhidt tm usi b riebthviey sjbee vmeuji mo

DbFe bs aypirtmdhf sbehdi. @hvid tai rifidt mksirvbthmds

gisfrhkig bkmvi, b pmstuebtig jifabdhsj ixpebhdhd`

aypirtmdhf sbehdi hdabebthmd tribtjidt pbrthfuebrey hd

[V_ krmdfahmehths hs prisidtig. Ourtair stughis tm fmdflrj

mr ghsputi tahs aypmtaishs bri wbrrbdtig.

BFCDMPEIG@JIDWV

Pi tabdc Jhfabie W. Diwamusi JG omr ahs chdg

frhthfhsj bdg su`ìsthmds.

[IOI[IDFIV

2. Gmdbegsmd VA. Aygrbtmr tairbphis omr fysthf flkrmshs eud` ghsibsi.

\ighbtr \uejmdme ;<<1376>V21 ‖V;6.

;. [bdgiee VA, Kmufair [F. Iooifthvi jufus feibrbdfi hs issidthbe

omr risphrbtmry aibeta. Bj N [isphr Fiee Jme Khme ;<<?369>;<‖;1.

6. Kmm`brg [F, gi Nmd`sti N, Jircus \. \abrjbfmtairbpy mo

hjpbhrig jufmfhehbry feibrbdfi hd dmd-FO pighbtrhf eud` ghsibsi.

B rivhiw mo tai ehtirbturi. \ighbtr \uejmdme ;<<037;>818 ‖2<<2.

7. Vmmg D, Kidditt PG, îjbd C, Krmwd N, Omy F, Kmufair [F,

Cdmweis J[. Hdfribshd fmdfidtrbthmd mo hdabeig sbehdi whta

mr whtamut bjhemrhgi> iooift md jufmfhehbry feibrbdfi hd dmrjbe

suknifts. Bj N [isphr Frht Fbri Jig ;<<632?0>291 ‖2?6.

9. Gbvhscbs I, Bdgirsmd VG. Aypirmsjmebr bìdts bdg feibrbdfi mo jufus hd tai ghsibsig bhrwby. N Birmsme Jig ;<<?328>2<< ‖2<8.

?. Pbhdwrh at F, Betbjhrbdm E, Faidiy J, Faidiy N, Kbrkir

V, \rhfi G, Jmemdiy V, Chjkireiy B, Pmmeflieg D, Fbgzmw V,

Ohujbrb O, Phesmd \, Ji m V, _bdgi_iegi G, Vbdgirs V,

M‘[murci \, Orbdfhs \. B juethfidtir, rbdgmjhzig, gmukei-kehdg,

fmdtrmeeig trhbe mo dikuehzig iphdiparhdi hd hdobdts whta bfuti

krmdfahmehths. D Idè N Jig ;<<63678>;0 ‖69.

0. \btie A, \ebtt [, Emzbdm NJ, Pbd` IIE. @eufmfmrthfmhgs omr

bfuti vhrbe krmdfahmehths hd hdobdts bdg ymud` fahegrid. Fmfarbdi

Gbtbkbsi Vyst [iv ;<<736>FG<<7101.

1. Gbrvheei W, Xbjbufah W. [isphrbtmry sydfythbe vhrus. \ighbtr [iv

2881328>99 ‖?2.

8. Wbrrbd [, @rukk K[, \brsmds G, \hfair J, Ahrsa BN, Gbvhs FP.

Kmufair Wai FO sbet fmdtrmvirsy> hd vhvm mksirvbthmds bdg

tairbpiuthf bpprmbfais. Jme Fiee ;<<231>278‖291.2<. Phees \N, Abee [E, Fabd P, Fmei \N. Vmghuj faemrhgi hdfribsis

tai fhehbry trbdspmrtbkhehty mo fysthf flkrmshs bdg krmdfahiftbshs

sputuj md tai jufus-gipeitig kmvhdi trbfaib. N Fehd Hdvist 28803

88>8‖26.

22. ^hjidt H. [isphrbtmry pabrjbfmem y bdg tairbpiuthfs. \ahebgie-

pahb> PK Vbudgirs3 2801.

2;. [mkhdsmd J, Aijjhd` BE, [i`dhs NB, Pmd` B@, Kbheiy GE,

Kbutmvhfa @N, Chd` J, Kyi \W. Iooift mo hdfribshd` gmsis mo

aypirtmdhf sbehdi md jufmfhehbry feibrbdfi hd pbthidts whta fysthf

flkrmshs. Wamrbx 288039;>8<<‖8<6.

26. Jbdgiekir` B, Wbe @, Phtzehd` J, Vmjifc I, Amurh V, Vbrriee J,

\rhie HI. Dikuehzig 6% aypirtmdhf sbehdi tribtjidt hd amsph-

tbehzig hdobdts whta vhrbe krmdfahmehths. Faist ;<<632;6>712‖

710.

27. Vbrriee IJ, Wbe @, Phtzehd` J, Vmjica I, Amurh V, Fmaid AB,Jbdgiekir B. Dikuehzig 6% aypirtmdhf sbehdi tribtjidt hd

bjkuebtmry fahegrid whta vhrbe krmdfahmehths gifribsis syjptmjs.

Faist ;<<;32;;>;29‖;;<.

29. Vjhta GP, Orbdcie E[, Jbtairs EA, Wbd` BW, Brhb dm [E,

\rmkir F@. B fmdtrmeeig trhbe mo birmsmehzig rhkbvhrhd hd hdobdts

rifihvhd` jifabdhfbe vidthebthmd omr siviri risphrbtmry sydfythbe

vhrus hdoifthmd. D Idè N Jig 288236;9>;7 ‖;8.

2?. Wbe @, Fisbr C, Mrmd B, Amurh V, Kbeehd B, Jbdgiekir B.

Aypirtmdhf sbehdi/iphdiparhdi tribtjidt hd amsphtbehzig hdobdts

whta vhrbe krmdfahmehths rigufis amsphtbehzbthmd stby> ; yibrs

ixpirhidfi. Hsr Jig Bssmf N ;<<?31>2?8‖206.

20. Cuzhc KB, Be Rbgah VB, Cidt V, Oebvhd J\, Ampjbd P, Amtti V,

@bdgir V. Dikuehzig aypirtmdhf sbehdi hd tai tribtjidt mo vhrbe

krmdfahmehths hd hdobdts. N \ighbtr ;<<03292>;?? ‖;0<.

21. âbd` E, Jidgmzb-Vbssh [B, Pbhdwrhàt F, Cebssid W\.Dikuehzig aypirtmdhf sbehdi smeuthmd omr bfuti krmdfahmehths hd

hdobdts. Fmfarbdi Gbtbkbsi Vyst [iv ;<<137> FG<<?791.

28. Bdhe BK, Bdhe J, Vbèbj BK, Fithd D, Kbe B, Bcsu D. Dikuehzig

sbekutbjme, iphdiparhdi, 6% sbehdi bdg dmrjbe sbehdi bri iqubeey

iooifthvi hd jheg krmdfahmehths hd pighbtrhf ijirìdfy gipbrtjidt.

\ighbtrhf \uejmdmem`y ;<<8.

;<. Pbhdwrh at F, Betbjhrbdm E, Faidiy J, Faidiy N, Kbrkir

V, \rhfi G, Jmemdiy V, Chjkireiy B, Pmmeflieg D, Fbgzmw V,

Ohujbrb O, Phesmd \, Ji m V, _bdgi_iegi G, Vbdgirs V,

M‘[murci \, Orbdfhs \. B juethfidtir, rbdgmjhzig, gmukei-kehdg,

fmdtrmeeig trhbe mo dikuehzig iphdiparhdi hd hdobdts whta bfuti

krmdfahmehths. D Idè N Jig ;<<6378>;0 ‖69.


7< Jbdgiekir` bdg Bjhrbv

hypertonic saline or high volume normal saline for viral bronchiolitis

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