Bronchiolitis (peds): Difference between revisions
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===Oxygen=== | ===Oxygen=== | ||
*The AAP guidelines also state that it is reasonable to not perform continuous oximetry on infants and children with bronchiolitis<ref name="AAP guides">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 [http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html PDF] | *The AAP guidelines also state that it is reasonable to not perform continuous oximetry on infants and children with bronchiolitis<ref name="AAP guides">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 [http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html PDF]<ref> | ||
*O2 (maintain SaO2 >90%) | *O2 (maintain SaO2 >90%) | ||
**oxygen saturation alone should not dictate admission<ref>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</ref> | **oxygen saturation alone should not dictate admission<ref>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</ref> | ||
===Albuterol=== | ===Albuterol=== | ||
*Do not administer bronchodilator therapy<ref name="AAP guides"></ref>([[Evidence_Based_Recommendation_Levels|Class B]]) | *Do not administer bronchodilator therapy<ref name="AAP guides"></ref>([[Evidence_Based_Recommendation_Levels|Class B]]) |
Revision as of 15:58, 30 November 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 Otitis Media, 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
Treatment
- Randomized controlled trials of bronchodilater or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.[1][2][3]
Oxygen
- The AAP guidelines also state that it is reasonable to not perform continuous oximetry on infants and children with bronchiolitisCite error: Closing
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missing for<ref>
tag
Albuterol
Epinephrine
Hypertonic Saline
- Suction nares / nasal saline drops
Suctioning
- Nasopharyngeal suctioning may temporarily relieve symptoms
- Do not perform deep suctioning since it will increase length of stay with no added benefit[4]
Steroids
Do not administer steroids[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
- ↑ 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
- ↑ 4.0 4.1 4.2 4.3 4.4 Cite error: Invalid
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tag; no text was provided for refs namedAAP guides
- ↑ 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