Nebulized hypertonic saline to prevent ventilator associated pneumonia in premature infants, a randomized trial.

Background/objectives: Ventilator associated pneumonia (VAP) is a leading cause of death. Nebulized hypertonic saline solution (HSS) has been used to improve pulmonary clearance and reduce infection in intubated patients. This study examines whether nebulized HSS may reduce VAP in intubated premature infants.

Methods: We analyzed results of 100 intubated premature infants who completed the study. Infants were divided into: (a) the "Control" group, where VAP prevention protocol was implemented and (b) the "Intervention" group, where nebulized HSS twice daily was added to the package of care. Clinical, radiologic, and laboratory evidence of VAP, endotracheal aspirate and blood cultures, and days on mechanical ventilation were compared between groups.

Results: VAP occurred in 18% in the intervention group compared to 52% in the control group, relative risk 0.35 (CI:0.18-0.66, p = .001). VAP incidence density was 16/1000 patient-ventilator days in intervention group versus 30/1000 in control group. There was a significant reduction in the days of mechanical ventilation in the intervention group (10.7 ± 8.6 and 16.9 ± 3.4, p < .001).

Conclusions: Nebulized HSS may help preserving lung clearance mechanisms and therefore reduce VAP in premature infants. Multi center, double blinded, randomized, controlled, trial is needed to confirm safety and efficacy of such intervention.