Florin 2014.

Methods	Design: randomised, double‐blind, parallel‐group, controlled trial
Participants	Setting: urban paediatric emergency department in USA Assessed for eligibility: 2256 Randomised: 31 hypertonic saline group (3% saline); 31 normal saline group Completed: 31 hypertonic saline group; 31 normal saline group Gender (male): 45.2% Age (mean ± SD): 7.2 ± 5.1 months in hypertonic saline group; 6.1 ± 3.6 months in normal saline group Inclusion criteria: children aged 2 months up to 24 months presenting to the emergency department with acute bronchiolitis, defined as a first episode of wheezing associated with signs and symptoms of respiratory distress and upper respiratory infection, with RDAI score of 4 to 15 (moderate to severe) Exclusion criteria: infants with a history of wheezing or asthma, bronchodilator therapy prior to the current illness, chronic lung or heart disease, critical illness, inability to receive nebulised medications, and infants with non–English‐speaking guardians
Interventions	Intervention group: nebulised 3% hypertonic saline (4 mL) Control group: nebulised 0.9% normal saline (4 mL) Treatment delivered using a jet nebuliser with an oxygen flow rate of 8 L/min. Study medication was given within 90 minutes after albuterol administration.
Outcomes	Respiratory assessment change score (RACS) Heart rate Respiratory rate Oxygen saturation Rate of hospitalisation Physician clinical impression (i.e. overall rating of clinical severity, categorised as mild, moderate, or severe) Parental perception of improvement in breathing and feeding (i.e. improved, worse, or unchanged) Adverse events
Notes	Virological identification not available.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random permuted block randomisation
Allocation concealment (selection bias)	Low risk	The investigational pharmacy prepared the study medications, which were stored in sequentially numbered envelopes with blinded syringes labelled only with the study number.
Blinding (performance bias and detection bias) All outcomes	Low risk	Double‐blind
Incomplete outcome data (attrition bias) All outcomes	Low risk	No withdrawals reported.
Selective reporting (reporting bias)	Low risk	All predefined outcomes reported.
Other bias	Low risk	No other bias found.