Management Of Acute Viral Bronchiolitis Research Articles

Acute viral bronchiolitis in infants: A narrative literature review

Severe acute bronchiolitis is mostly caused by the respiratory syncytial virus (RSV) and is the main cause of hospitalization in children under one year old. Although it has a low mortality rate, it has a high morbidity rate, requiring early diagnosis through a detailed clinical history and physical examination. A narrative review of fourteen articles found in the PubMED/MEDLINE, SciELO and BVS electronic databases was therefore carried out, with the aim of reviewing the most up-to-date literature on the subject. Currently, the monoclonal antibody Palivizumab is the main agent used to prevent bronchiolitis and is available for patients at high risk of developing the serious disease. In addition, the Abryso vaccine was recently approved by the National Health Surveillance Agency (Anvisa) and will be administered to pregnant women in the last trimester of pregnancy, with the aim of preventing the disease in newborns. Finally, it was found that the appropriate management of acute viral bronchiolitis consists of supportive measures such as hydration, nutritional support and oxygenation when necessary, while the use of corticosteroids and bronchodilators has not been shown to reduce the length of hospital stay or the natural course of the disease.

Predictors of admission in patients with acute Bronchiolitis

Background: Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants and young children less than 24 months and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute bronchiolitis. Most children with bronchiolitis have a self-limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute viral bronchiolitis, Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment. Aim: To identify the epidemiological profile of babies less than 2 years with bronchiolitis, clinical characteristics of babies with bronchiolitis in respect to the main symptoms, signs and clinical presentations and the factors that affect disposition of the patient with acute bronchiolitis. Patient and Method: Design: A prospective observational case series study. Setting: Emergency unit in Al-Khansaa Teaching Hospital. Study period: one-year (1/October/ 2012 – 30/September/ 2013) Sample size: 84 patients were enrolled in this study. Inclusion criteria: 1-first attack of acute wheeze due to bronchiolitis.2-age 2years or younger. Exclusion criteria: 1. patients with more than one attack wheezes.2. wheezes due to other cause (pneumonia).3.age more than 2 years. Result: A Total of 84 patients with 1st attack wheeze in less than 2 years identified. The main age was 8.2±5.77months, and the peak age was 6 months.53 (63.1%) male, and 31(36.9%) female and ratio of 1.7:1.and the majority were mature babies, came from urban area more than rural area. The comparison done concentrated on symptoms, signs, and radiological findings between babies younger and older than 6months age and studied either to hospital or not and concentrated these findings had role as an indicator for admission on heart rate, respiratory rate and SPO2, The results indicated that poor feeding, irritability, runny nose, cough and shortness of breath all of these symptoms consider a good indicators for admission in both age groups. Severe retraction, rhonchi, and temperature more than 38.1 C, all of these physical findings consider good indicators of admission in both age groups. While fine rales and cyanosis are good indicators in babies younger than 6 months only. Radiological findings had no role in assessing admission of the patients to hospital. Respiratory rate (tachypnea)>60 bpm, and SPO2 160 BPM consider significant indicator only in babies older than 6 months of age. Of all 84 patients admitted to emergency unit, only 63(75%) of them were admitted to hospital and the remaining were discharged. Conclusion: Indications of admission can be assessed by many symptoms (poor feeding, irritability, runny nose, cough, and SOB) and physical signs (Rhonchi, severe retraction, temperature >38.1 c, RR>60bpm, and SPO2<94), so We recommended carrying out serial checking SPO2 by pulse oximetry, and to conduct arterial or capillary blood gas analysis for the severely ill patients to assess the severity of the disease and its complications and treatment procedures.

Welche Atemunterstützung bei akuter viraler Bronchiolitis im Säuglingsalter?

Milési C et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med 2017; 43: 209 – 216

High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).

Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants. A randomized controlled trial was performed in five pediatric intensive care units (PICUs) to compare 7cmH2O nCPAP with 2L/kg/min oxygen therapy administered with HFNC in infants up to 6months old with moderate to severe AVB. The primary endpoint was the percentage of failure within 24h of randomization using prespecified criteria. To satisfy noninferiority, the failure rate of HFNC had to lie within 15% of the failure rate of nCPAP. Secondary outcomes included success rate after crossover, intubation rate, length of stay, and serious adverse events. From November 2014 to March 2015, 142 infants were included and equally distributed into groups. The risk difference of -19% (95% CI -35 to -3%) did not allow the conclusion of HFNC noninferiority (p=0.707). Superiority analysis suggested a relative risk of success 1.63 (95% CI 1.02-2.63) higher with nCPAP. The success rate with the alternative respiratory support, intubation rate, durations of noninvasive and invasive ventilation, skin lesions, and length of PICU stay were comparable between groups. No patient had air leak syndrome or died. In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP. This clinical trial was recorded in the National Library of Medicine registry (NCT 02457013).

Acute viral bronchiolitis in South Africa: Strategies for management and prevention

Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxic children. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropium bromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids, inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterial co-infection is suspected. Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab, administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, young children with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should be commenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a more effective alternative to prevent disease, for which the results of clinical trials are awaited. Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following: bronchiolitis is caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms are cough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, although symptoms may occur for up to four weeks in some children.

Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an : actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO)

While our European and North American colleagues have recently updated their recommendations, the 2000 Consensus Conference remains the main guideline on management of acute viral bronchiolitis in France. We aimed to establish an updated inter-regional protocol on management of acute viral bronchiolitis in infants. Pediatricians, pediatric pulmonologists, and emergency physicians of the Grand Ouest University Hospitals (France) gathered to analyze the recent data from the literature. Criteria to distinguish childhood asthma from acute viral bronchiolitis were established, then prescriptions of diagnostic tests, antibiotics, and chest physiotherapy were defined and reserved for very limited situations. Similarly, the modalities of oxygen therapy prescription and nutritional support were proposed. Finally, other therapeutics such as nebulized hypertonic saline seem promising, but their place in the treatment of acute bronchiolitis in infants remains unclear. This work has provided new proposals for management of acute viral bronchiolitis and helped standardize practices within the Grand Ouest University Hospitals. This local organization could lay the keystone for working toward guidelines initiated by learned societies at the national level.

Treatment of acute viral bronchiolitis.

Acute viral bronchiolitis represents the most common lower respiratory tract infection in infants and young children and is associated with substantial morbidity and mortality. Respiratory syncytial virus is the most frequently identified virus, but many other viruses may also cause acute bronchiolitis. There is no common definition of acute viral bronchiolitis used internationally, and this may explain part of the confusion in the literature. Most children with bronchiolitis have a self limiting mild disease and can be safely managed at home with careful attention to feeding and respiratory status. Criteria for referral and admission vary between hospitals as do clinical practice in the management of acute viral bronchiolitis, and there is confusion and lack of evidence over the best treatment for this condition. Supportive care, including administration of oxygen and fluids, is the cornerstone of current treatment. The majority of infants and children with bronchiolitis do not require specific measures. Bronchodilators should not be routinely used in the management of acute viral bronchiolitis, but may be effective in some patients. Most of the commonly used management modalities have not been shown to have a clear beneficial effect on the course of the disease. For example, inhaled and systemic corticosteroids, leukotriene receptor antagonists, immunoglobulins and monoclonal antibodies, antibiotics, antiviral therapy, and chest physiotherapy should not be used routinely in the management of bronchiolitis. The potential effect of hypertonic saline on the course of the acute disease is promising, but further studies are required. In critically ill children with bronchiolitis, today there is little justification for the use of surfactant and heliox. Nasal continuous positive airway pressure may be beneficial in children with severe bronchiolitis but a large trial is needed to determine its value. Finally, very little is known on the effect of the various interventions on the development of post-bronchiolitic wheeze.

Implementation of evidence-based management of acute bronchiolitis.

Implementation of clinical guidelines is frequently delayed well beyond their dissemination and the publication of clinical evidence. The recently published Australian guidelines for the management of acute viral bronchiolitis (AVB) have been evaluated by assessing the current practice of Australian paediatricians. Questionnaire survey of all Australian paediatricians and a review of the literature. Of a total of 891 questionnaires, 555 (62%) were returned. Of the respondents, 373 (67%) treated children with AVB and, of these, 232 (67%) treated 10-50 children per year. A wide variation in management practice for both outpatient and inpatient treatment of AVB was identified. Up to 70% of paediatricians who treated AVB indicated using pharmaceutical agents in their outpatient management (88% in inpatient management), most using these agents 'sometimes' or in high-risk children. Paediatric respiratory physicians tended to use bronchodilators less frequently than general paediatricians. Compared with many countries in Europe, few Australian paediatricians routinely use supplementary drugs in the inpatient managenment of AVB; in particular, bronchodilators (61 vs 7%) and corticosteroids (11 vs 1%) are used far less often. A review of the literature demonstrated that pharmaceutical agents do not influence the course of AVB. Despite a lack of evidence for their efficacy and the recommendation of the Australian guidelines, pharmaceutical agents are frequently used in the management of AVB by paediatricians in Australia, although far less than reported in a recently published European survey. Guidelines alone are not sufficient to implement change and there is a need for more specific strategies to ensure that children receive appropriate management for this common condition.

An Evaluation of Chest Physiotherapy in the Management of Acute Bronchiolitis: Changing clinical practice

Summary Aims A clinical trial was undertaken to test the hypothesis that CPT may be of benefit to those infants with acute viral bronchiolitis whose disease on admission was severe enough to require nasogastric or intravenous feeding. The clinical impression that CPT does not increase respiratory distress was also investigated. Method The treatment group (n = 26) receiving physiotherapy was compared with a control group (n = 24). Subjects in the control group were nursed in modified postural drainage positions with suction as required. Outcome was assessed by comparison of clinical score, duration of hospital stay, requirement for oxygen, and nasogastric feeding. Results There was no significant difference in overall outcomes between the two groups. Analysis of clinical scores suggested that less severely ill infants (score Conclusions There was no increase in the respiratory distress of infants who received CPT according to the protocol, but chest physiotherapy is of no benefit in the management of acute viral bronchiolitis in the absence of other pathologies.

Management of Acute Viral Bronchiolitis in Infancy

In the recent article by Drs. Wright and Beem, "Acute Viral Bronchiolitis in Infancy" (Pediatrics, 35:334), they state that tracheotomy should be condemned in the therapy of this illness. Although I agree with most of their points, I must take issue with this particular statement. We have found, at this hospial, that tracheotomy may be a life-saving procedure in the child who is severely afflicted with bronchiolitis. This may not be an isolated opinion since Dr. Walter Anyan, who has recently joined our staff, after serving a year as Registrar at St. Mary's Hospital in London, England, reports that he also has seen tracheotomy to be of benefit.