Osmotic agent. Draws water into airway lumen → rehydrates periciliary liquid layer → restores mucociliary clearance. Also reduces sodium absorption and may reduce airway surface liquid depletion.
Dosing
Adult
3% or 7% NaCl; 4 mL SVN BID (CF). 3% used for atelectasis/airway clearance in ICU
Pediatric
3–7% NaCl 4 mL SVN BID
Neonatal
3% NaCl 4 mL SVN for thick secretions (off-label)
Indications
Cystic fibrosis — improves mucociliary clearance
Non-CF bronchiectasis
Atelectasis
Neonates: sodium supplementation via nebulization in certain cases
Contraindications
Airway hyperreactivity (pre-treat with bronchodilator)
Side effects
Bronchospasm (most important — pre-treat with albuterol)