Canadian Pediatric Society or CPS guidelines on bronchiolitis suggest that the following
may be reasons to admit a patient:
• Signs of severe respiratory distress;
• The need for supplemental O2 to keep oxygen saturations above 90%;
• Dehydration or poor fluid intake;
• Cyanosis or a history of apnea; and/or
• The family is unable to cope.
Patients can be discharged if: • Tachypnea and work of breathing are improved; • They can maintain O2 saturations above 90% without the need for supplemental oxygen; and • They have adequate oral feeding.
parents know the signs of deterioration and that they indicate a need to seek medical attention immediately. These signs are: • Apnea; • Cyanosis; • Poor feeding or decreased fluid intake (<75 12="" and="" breathing="" diaper="" fever="" for="" hours="" increased="" lethargy.="" nbsp="" new="" no="" normal="" of="" or="" p="" rate="" respiratory="" wet="" work="" xhaustion="">
Let’s summarize: 1. Acute bronchiolitis is a self-limiting illness characterized by inflammation of the lower respiratory tract and increased mucus production, typically from a viral source such as RSV. The result is airway obstruction, which can present as tachypnea, increased respiratory effort, wheeze, lethargy and poor feeding. 2. The differential diagnosis for wheeze in infants is long. This is why a thorough and focused history and physical exam, as well as consideration of risk factors is important. Patients with acute bronchiolitis will present with a history of an upper respiratory tract infection such as runny nose, fever, and cough, followed by signs of respiratory distress, decreased feeding and, in severe cases, exhaustion. 3. The diagnosis of bronchiolitis is based the history and physical exam. Routine laboratory tests or imaging are not indicated unless the diagnosis is uncertain. 4. The decision to treat as an inpatient or an outpatient is based on clinical judgment, risk factors for severe illness, and the need for supportive care and monitoring in a hospital setting. 5. The mainstay of treatment is supportive care in the form of O2 supplementation to maintain an oxygen saturation of above 90%, gentle nasal suctioning, and maintaining adequate hydration status, which may require NG or IV fluid supplementation. 6. Parent education and follow-up is very important. Make sure that parents know what the signs of deterioration are and when to come back to the hospital, and that patients are followed-up to ensure adequate recovery.
Patients can be discharged if: • Tachypnea and work of breathing are improved; • They can maintain O2 saturations above 90% without the need for supplemental oxygen; and • They have adequate oral feeding.
parents know the signs of deterioration and that they indicate a need to seek medical attention immediately. These signs are: • Apnea; • Cyanosis; • Poor feeding or decreased fluid intake (<75 12="" and="" breathing="" diaper="" fever="" for="" hours="" increased="" lethargy.="" nbsp="" new="" no="" normal="" of="" or="" p="" rate="" respiratory="" wet="" work="" xhaustion="">
Let’s summarize: 1. Acute bronchiolitis is a self-limiting illness characterized by inflammation of the lower respiratory tract and increased mucus production, typically from a viral source such as RSV. The result is airway obstruction, which can present as tachypnea, increased respiratory effort, wheeze, lethargy and poor feeding. 2. The differential diagnosis for wheeze in infants is long. This is why a thorough and focused history and physical exam, as well as consideration of risk factors is important. Patients with acute bronchiolitis will present with a history of an upper respiratory tract infection such as runny nose, fever, and cough, followed by signs of respiratory distress, decreased feeding and, in severe cases, exhaustion. 3. The diagnosis of bronchiolitis is based the history and physical exam. Routine laboratory tests or imaging are not indicated unless the diagnosis is uncertain. 4. The decision to treat as an inpatient or an outpatient is based on clinical judgment, risk factors for severe illness, and the need for supportive care and monitoring in a hospital setting. 5. The mainstay of treatment is supportive care in the form of O2 supplementation to maintain an oxygen saturation of above 90%, gentle nasal suctioning, and maintaining adequate hydration status, which may require NG or IV fluid supplementation. 6. Parent education and follow-up is very important. Make sure that parents know what the signs of deterioration are and when to come back to the hospital, and that patients are followed-up to ensure adequate recovery.
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