Bronchiolitis (peds): Difference between revisions
Ostermayer (talk | contribs) |
|||
| Line 44: | Line 44: | ||
#CA | #CA | ||
==Treatment== | ==Treatment<ref>Cherry J. Clinical practice. Croup. NEJM. 2008; 358; 68:453-456</ref><ref>Zorc J. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010: 125:343-349</ref>== | ||
#O2 (maintain SaO2 >90%) | #O2 (maintain SaO2 >90%) | ||
#Racemic epi neb | #Racemic epi neb | ||
| Line 50: | Line 50: | ||
#+/- albuterol | #+/- albuterol | ||
#Suction nares / nasal saline drops | #Suction nares / nasal saline drops | ||
#Steroids | #Steroids | ||
##Consider 0.6mg/kg of dexamethasone | |||
;Randomized controlled trials of bronchodilater or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.<ref>Bjornson CL. et al. A randomized trial of a single dose of oral dexamethasone for mild croup. NEJM. 2004;351:1306-1313.</ref><ref>Geelhoed GC. et al. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ. 1996;313:140-142</ref>.<ref>Ralston S. et al. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005;40:292-299</ref> | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:29, 21 March 2014
Background
- <2yr old (peak 2-6mo age)
- Preemies, neonates, congenital heart dz are at risk for serious disease
- Peaks in winter
- Duration = 7-14d (worst during days 3-5)
- Inflammation, edema, and epithelial necrosis of bronchioles
Diagnosis
- Symptoms
- Rhinorrhea, cough, irritability, apnea (neonates)
- Signs
- Tachypnea, cyanosis, wheezing, retractions
- Fever is usually low-grade or absent
- If high-grade fever consider OM, UTI
- Assess for dehydration (tachypnea may interfere with feeding)
Work-Up
- Rapid RSV
- Obtain if <1mo old
- If positive then admit pt
- CXR
- Not routinely necessary
- May lead to unnecessary use of abx (atelectais mimics infiltrate)
- Consider if
- Diagnosis unclear
- Critically ill
- Not routinely necessary
- Infants <60 days with RSV bronchiolitis and fever
- Concern is for SBI with RSV
- UTI 5.4% in RSV+, 10.1% RSV-
- Bacteremia 1.1% RSV+, 2.3% RSV-
- Meningitis 0% RSV+, 0.9% RSV-
- CONCLUSION-Low risk of bacteremia and meningitis in RSV+, still appreciable UTI risk
DDx
- Asthma
- PNA
- FB
- Pertusis
- CHF
- Cystic fibrosis
- Vascular ring
- CA
Treatment[1][2]
- O2 (maintain SaO2 >90%)
- Racemic epi neb
- Only repeat if initial beneficial response
- +/- albuterol
- Suction nares / nasal saline drops
- Steroids
- Consider 0.6mg/kg of dexamethasone
- Randomized controlled trials of bronchodilater or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.[3][4].[5]
Disposition
Consider admission for:
- Age <3months
- Preterm (<34wks)
- Underlying heart/lung disease
- Initial SaO2 <92%
- Unable to tolerate PO
See Also
Source
- Rosen's, Tintinalli
- Pediatrics.2004 Jun;113(6):1728-34
- ↑ Cherry J. Clinical practice. Croup. NEJM. 2008; 358; 68:453-456
- ↑ Zorc J. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010: 125:343-349
- ↑ Bjornson CL. et al. A randomized trial of a single dose of oral dexamethasone for mild croup. NEJM. 2004;351:1306-1313.
- ↑ Geelhoed GC. et al. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ. 1996;313:140-142
- ↑ Ralston S. et al. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005;40:292-299