Bronchiolitis (peds): Difference between revisions
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==Disposition== | ==Disposition== | ||
===Consider Admission=== | ===Consider Admission=== | ||
*Age <3months | |||
*Preterm (<34wks) | |||
*Underlying heart/lung disease | |||
*Initial SaO2 <90% | |||
**Sa02 alone should not be used as the only factor for admission<ref>Schuh S, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014; 312(7):712-718.</ref> | |||
*Unable to tolerate PO | |||
===Consider Discharge=== | ===Consider Discharge=== | ||
*Conventional treatment used (epi, dex) and no rebound stridor in 2h<ref>Ross JD, et al. The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department. J Emerg Med. 1998; 16:535-539.</ref><ref>Kelley PB, et al. Racemic epinephrine use in croup and disposition. J Emerg Med. 1992; 10:181-183.</ref> | |||
==See Also== | ==See Also== | ||
[[Croup]] | [[Croup]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Peds]] [[Category:Pulm]] | [[Category:Peds]] [[Category:Pulm]] | ||
[[Category:ID]] [[Category:Featured]] | [[Category:ID]] [[Category:Featured]] | ||
Revision as of 00:17, 22 September 2015
Background
- <2yr old (peak 2-6mo age)
- Respiratory Syncytial Virus (RSV) causes ~70% of cases[1]
- 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
Clinical Features
- Symptoms
- Rhinorrhea, cough, irritability, apnea (neonates)
- Signs
- Tachypnea, cyanosis, wheezing, retractions
- Fever is usually low-grade or absent
- If high-grade fever consider Otitis Media, UTI
- Assess for dehydration (tachypnea may interfere with feeding)
Differential Diagnosis
Diagnosis
- 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
Concurrent infection risk
Infants <60 days with RSV bronchiolitis and fever
- Low risk of bacteremia and meningitis in RSV+, still appreciable UTI risk
- UTI 5.4% in RSV+, 10.1% RSV-
- Bacteremia 1.1% RSV+, 2.3% RSV-
- Meningitis 0% RSV+, 0.9% RSV-
Treatment
- Randomized controlled trials of bronchodilater or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.[2][3][4]
Oxygen
- The AAP guidelines also state that it is reasonable to not perform continuous oximetry on infants and children with bronchiolitis[5]
- O2 (maintain SaO2 >90%)
- oxygen saturation alone should not dictate admission[6]
Hypertonic Saline
- Suction nares / nasal saline drops
Although AAP recommends as a possible intervention. the SABRE trial found no support the use of nebulised HS in the treatment of acute bronchiolitis in regard to time to discharge or adverse events. [7]
Suctioning
- Nasopharyngeal suctioning may temporarily relieve symptoms
- Do not perform deep suctioning since it will increase length of stay with no added benefit[5]
Not indicated
Disposition
Consider Admission
- Age <3months
- Preterm (<34wks)
- Underlying heart/lung disease
- Initial SaO2 <90%
- Sa02 alone should not be used as the only factor for admission[9]
- Unable to tolerate PO
Consider Discharge
See Also
References
- ↑ Papadopoulos NG; Moustaki M; Tsolia M; Bossios A; Astra E; Prezerakou A (2002). Am J Respir Crit Care Med.
- ↑ 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
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Ralston S. et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics 134(5) Nov. 2014. 1474 -e150 doi: 10.1542/peds.2014-2742 PDF
- ↑ Schuh S. et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014 Aug 20;312(7):712-8. doi: 10.1001/jama.2014.8637
- ↑ Everard ML, Hind D, Ugonna K, et al. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis. Thorax. 2014;69(12):1105–1112. doi:10.1136/thoraxjnl-2014-205953.
- ↑ Corneli HM, Zorc JJ, Mahajan P, et al; Bronchiolitis Study Group of the Pediatric Emergency Care Applied Research Net- work (PECARN). A multicenter, random- ized, controlled trial of dexamethasone for bronchiolitis [published correction appears in N Engl J Med 2008;359(18): 1972]. N Engl J Med. 2007;357(4):331–339
- ↑ Schuh S, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014; 312(7):712-718.
- ↑ Ross JD, et al. The disposition of children with croup treated with racemic epinephrine and dexamethasone in the emergency department. J Emerg Med. 1998; 16:535-539.
- ↑ Kelley PB, et al. Racemic epinephrine use in croup and disposition. J Emerg Med. 1992; 10:181-183.