Abstract
Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition. In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a “minimal handling approach” is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.
Highlights
Bronchiolitis is an acute lower respiratory tract infection in early childhood caused by different viruses, with coughing, wheeze and poor nutrition as the major symptoms [1,2,3]
We performed a non-systematic search in PubMed up to January 2014, with the following words in different combinations; bronchiolitis, infants, children, severe, epidemiology, pathophysiology, guidelines, treatment, management, oxygen, hypertonic, saline, adrenaline, steroids, fluid, nutrition, continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP), high flow nasal cannulae and ventilation
In 2006, a subcommittee of the American Academy of Pediatrics (AAP) together with the European Respiratory Society (ERS) underlined that bronchiolitis is a clinical diagnosis, recognized as “a constellation of clinical symptoms and signs including a viral upper respiratory prodrome followed by increased respiratory effort and wheezing in children less than 2 years of age” [3]
Summary
Bronchiolitis is an acute lower respiratory tract infection in early childhood caused by different viruses, with coughing, wheeze and poor nutrition as the major symptoms [1,2,3]. Respiratory syncytial virus (RSV) is the most common virus causing bronchiolitis, occurring in epidemics during winter months [1,2]. Some infants, those with risk factors, will have a severe course of bronchiolitis. Bronchiolitis is the most common medical reason for admission of children to intensive care units (ICU), providing challenges regarding ventilation, fluid balance and general support [5]. This may be a particular challenge for ICUs without a specialised paediatric section
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