tetano
Editor, Senior Moderator
Ear Nose Throat J
. 2022 Aug 25;1455613221123737.
doi: 10.1177/01455613221123737. Online ahead of print.
Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients
Amy L Baxter[SUP] 1 [/SUP], Kyle R Schwartz[SUP] 2 [/SUP], Ryan W Johnson[SUP] 3 [/SUP], Ann-Marie Kuchinski[SUP] 1 [/SUP], Kevin M Swartout[SUP] 4 [/SUP], Arni S R Srinivasa Rao[SUP] 5 6 [/SUP], Robert W Gibson[SUP] 1 [/SUP], Erica Cherian[SUP] 3 [/SUP], Taylor Giller[SUP] 3 [/SUP], Houlton Boomer[SUP] 1 [/SUP], Matthew Lyon[SUP] 1 [/SUP], Richard Schwartz[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity.
Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive.
Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X[SUP]2[/SUP] = 8.728, P = .0031) regardless of additive.
Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.
Keywords: COVID-19; SARS-COV-2; coronavirus; nasal lavage; povidone-iodine.
. 2022 Aug 25;1455613221123737.
doi: 10.1177/01455613221123737. Online ahead of print.
Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients
Amy L Baxter[SUP] 1 [/SUP], Kyle R Schwartz[SUP] 2 [/SUP], Ryan W Johnson[SUP] 3 [/SUP], Ann-Marie Kuchinski[SUP] 1 [/SUP], Kevin M Swartout[SUP] 4 [/SUP], Arni S R Srinivasa Rao[SUP] 5 6 [/SUP], Robert W Gibson[SUP] 1 [/SUP], Erica Cherian[SUP] 3 [/SUP], Taylor Giller[SUP] 3 [/SUP], Houlton Boomer[SUP] 1 [/SUP], Matthew Lyon[SUP] 1 [/SUP], Richard Schwartz[SUP] 1 [/SUP]
Affiliations
- PMID: 36007135
- DOI: 10.1177/01455613221123737
Abstract
Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity.
Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive.
Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X[SUP]2[/SUP] = 8.728, P = .0031) regardless of additive.
Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.
Keywords: COVID-19; SARS-COV-2; coronavirus; nasal lavage; povidone-iodine.