Article short contents


Slovenska pediatrija 2018; 25: 284-298


Review article

UP-TO-DATE MANAGEMENT OF CHILDREN WITH ACUTE BRONCHIOLITIS

M. Praprotnik
Služba za pljučne bolezni, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

A. Kotnik Pirš
Služba za pulmologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija; Katedra za pediatrijo, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija

A. Zver
Služba za pljučne bolezni, Pediatrična klinika, Univerzitetni klinični center, Ljubljana, Slovenija

M. Aldeco
Služba za pljučne bolezni, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

D. Lepej
Služba za pljučne bolezni, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

T. Mrvič
Klinika za infekcijske bolezni in vročinska stanja, Univerzitetni klinični center, Ljubljana, Slovenija

U. Krivec
Služba za pljučne bolezni, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

Acute bronchiolitis is the most common cause of hospital admission in children before the second year of age. The diagnosis of bronchiolitis should be made clinically on the basis of the history and physical examination. Based on available evidence, routine laboratory and radiological investigations are generally not recommended for bronchiolitis, except in cases where the diagnosis is uncertain or there are complications. Routine virological testing is generally not recommended in bronchiolitis, as test results will not alter the clinical management. Recently, the high rate of coinfection with multiple viruses has called cohorting into question. It is important to recognise and actively look for risk factors, which can contribute to a more severe course, such as age under 12 weeks, chronic heart and lung diseases, prematurity and some genetic and congenital factors. The indications for hospital admission include saturation ≤92% in room air as oxygen saturation can decrease in the hours after admission, and significantly increased work of breathing and dehydration. Discharge should be planned, if other clinical signs and symptoms are improving as well, at a saturation ≥ 90% in room air for at least 8 hours, including during sleep. In this period, continued improvement can be expected as any hypoxaemia is likely to be mild and of short duration. Treatment is supportive, including hydration and supplemental oxygen, if required. The administration of bronchodilators, glucocorticoids and antibiotics (the risk of secondary bacterial infection is very low and there is the potential harm of antibiotic use from adverse reactions and increased antibiotic resistance) and respiratory physiotherapy is not recommended as they do not improve the course. In children older than 1 year, the bronchodilator test can be performed and inhalation continued only if it is positive. Data regarding the administration of nebulized hypertonic (3%) saline are contradictory. This treatment may be considered for inpatients with bronchiolitis, probably in combination with bronchodilators, but it should not be administered in the emergency department. Non-invasive respiratory support with high-flow nasal cannulas is being used more frequently on hospital wards, while respiratory support with continuous positive airway pressure, due to its specific requirements, such as specific equipment, trained teams and continuous monitoring and supervision, should be provided only in PICU.

Key words: acute bronchiolitis, child, treatment, guidelines.

More ...