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Mellick LB. The De-implementation of Bronchiolitis Medications: Is It Time for a Moratorium? Pediatr Emerg Care 2024; 40:e30-e32. [PMID: 37665971 DOI: 10.1097/pec.0000000000003049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Larry B Mellick
- Department of Emergency Medicine, Augusta University, Augusta, GA
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Naveed H, Munir S, Rafiq K, Tayyab A, Naseer N, Hussain I, Halim M, Mumtaz H. Comparison of nebulised 3% hypertonic saline with ipratropium bromide in treatment of children with bronchiolitis: a randomized control trial. Ann Med Surg (Lond) 2023; 85:5484-5490. [PMID: 37915631 PMCID: PMC10617857 DOI: 10.1097/ms9.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/04/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Several drugs are in use for nebulization in children with acute bronchiolitis and no study has yet been conducted to compare the treatment outcome of nebulized ipratropium bromide and nebulized 3% hypertonic saline in Pakistan. Objective The objective was to compare the treatment outcome of nebulized hypertonic saline and ipratropium bromide in children with acute bronchiolitis. Setting Department of Pediatrics. Study duration October 2019 to March 2020. Subjects and methods A total of one hundred (n=100) children of either sex diagnosed with acute bronchiolitis were enrolled and randomized either to be nebulized with 3% hypertonic saline or ipratropium bromide. Outcomes were assessed in terms of respiratory rate, heart rate, and SpO2 and respiratory distress assessment instrument score at different time intervals, length of hospital stay, and need of admission. Results Respiratory rate and SPO2 improved significantly at 60 min and 24 h, respiratory distress assessment instrument improved significantly at 30 min, 60 min, and 24 h after the treatment in patients who were nebulized with hypertonic saline when compared to those nebulized with ipratropium bromide. The length of hospital stay was significantly shorter (2.63 vs. 3.82 days, P=0.008) and a lesser number of patients needed hospital admission (22% vs. 44%, P=0.019) in patients who were nebulized with hypertonic saline when compared to those nebulized with ipratropium bromide. Conclusions Nebulization with 3% hypertonic saline resulted in significant improvement in symptoms, a shorter duration of hospital stay, and a lesser number of hospital admissions as compared to nebulization with ipratropium bromide in children with acute bronchiolitis.
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Affiliation(s)
| | | | | | | | | | | | | | - Hassan Mumtaz
- Clinical Research Associate, Maroof International Hospital Public Health Scholar, Health Services Academy
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Zhang L, Mendoza-Sassi RA, Wainwright CE, Aregbesola A, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2023; 4:CD006458. [PMID: 37014057 PMCID: PMC10072872 DOI: 10.1002/14651858.cd006458.pub5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and updated in 2010, 2013, and 2017. OBJECTIVES To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 13 January 2022. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 13 January 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department (ED) trials was rate of hospitalisation. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics. MAIN RESULTS We included six new trials (N = 1010) in this update, bringing the total number of included trials to 34, involving 5205 infants with acute bronchiolitis, of whom 2727 infants received hypertonic saline. Eleven trials await classification due to insufficient data for eligibility assessment. All included trials were randomised, parallel-group, controlled trials, of which 30 were double-blinded. Twelve trials were conducted in Asia, five in North America, one in South America, seven in Europe, and nine in Mediterranean and Middle East regions. The concentration of hypertonic saline was defined as 3% in all but six trials, in which 5% to 7% saline was used. Nine trials had no funding, and five trials were funded by sources from government or academic agencies. The remaining 20 trials did not provide funding sources. Hospitalised infants treated with nebulised hypertonic saline may have a shorter mean length of hospital stay compared to those treated with nebulised normal (0.9%) saline or standard care (mean difference (MD) -0.40 days, 95% confidence interval (CI) -0.69 to -0.11; 21 trials, 2479 infants; low-certainty evidence). Infants who received hypertonic saline may also have lower postinhalation clinical scores than infants who received normal saline in the first three days of treatment (day 1: MD -0.64, 95% CI -1.08 to -0.21; 10 trials (1 outpatient, 1 ED, 8 inpatient trials), 893 infants; day 2: MD -1.07, 95% CI -1.60 to -0.53; 10 trials (1 outpatient, 1 ED, 8 inpatient trials), 907 infants; day 3: MD -0.89, 95% CI -1.44 to -0.34; 10 trials (1 outpatient, 9 inpatient trials), 785 infants; low-certainty evidence). Nebulised hypertonic saline may reduce the risk of hospitalisation by 13% compared with nebulised normal saline amongst infants who were outpatients and those treated in the ED (risk ratio (RR) 0.87, 95% CI 0.78 to 0.97; 8 trials, 1760 infants; low-certainty evidence). However, hypertonic saline may not reduce the risk of readmission to hospital up to 28 days after discharge (RR 0.83, 95% CI 0.55 to 1.25; 6 trials, 1084 infants; low-certainty evidence). We are uncertain whether infants who received hypertonic saline have a lower number of days to resolution of wheezing compared to those who received normal saline (MD -1.16 days, 95% CI -1.43 to -0.89; 2 trials, 205 infants; very low-certainty evidence), cough (MD -0.87 days, 95% CI -1.31 to -0.44; 3 trials, 363 infants; very low-certainty evidence), and pulmonary moist crackles (MD -1.30 days, 95% CI -2.28 to -0.32; 2 trials, 205 infants; very low-certainty evidence). Twenty-seven trials presented safety data: 14 trials (1624 infants; 767 treated with hypertonic saline, of which 735 (96%) co-administered with bronchodilators) did not report any adverse events, and 13 trials (2792 infants; 1479 treated with hypertonic saline, of which 416 (28%) co-administered with bronchodilators and 1063 (72%) hypertonic saline alone) reported at least one adverse event such as worsening cough, agitation, bronchospasm, bradycardia, desaturation, vomiting and diarrhoea, most of which were mild and resolved spontaneously (low-certainty evidence). AUTHORS' CONCLUSIONS Nebulised hypertonic saline may modestly reduce length of stay amongst infants hospitalised with acute bronchiolitis and may slightly improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation amongst outpatients and ED patients. Nebulised hypertonic saline seems to be a safe treatment in infants with bronchiolitis with only minor and spontaneously resolved adverse events, especially when administered in conjunction with a bronchodilator. The certainty of the evidence was low to very low for all outcomes, mainly due to inconsistency and risk of bias.
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Affiliation(s)
- Linjie Zhang
- Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
| | | | - Claire E Wainwright
- Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia
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Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, Zampogna S, Carnielli VP, Favilli S, Ruggieri M, Perri D, Di Mauro G, Gattinara GC, D’Avino A, Becherucci P, Prete A, Zampino G, Lanari M, Biban P, Manzoni P, Esposito S, Corsello G, Baraldi E. UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr 2023; 49:19. [PMID: 36765418 PMCID: PMC9912214 DOI: 10.1186/s13052-022-01392-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/12/2023] Open
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
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Affiliation(s)
- Sara Manti
- grid.10438.3e0000 0001 2178 8421University of Messina, Messina, Italy
| | - Annamaria Staiano
- grid.4691.a0000 0001 0790 385XSIP “Società Italiana di Pediatria”, University “Federico II”, Naples, Italy
| | - Luigi Orfeo
- grid.476687.c0000 0001 0944 2874SIN “Società Italiana di Neonatologia”, Hospital San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabio Midulla
- grid.7841.aSIMRI ”Società Italiana per le Malattie Respiratorie Infantili”, University of Rome “La Sapienza”, Rome, Italy
| | - Gian Luigi Marseglia
- grid.419425.f0000 0004 1760 3027SIAIP “Società Italiana di Allergologia e Immunologia Pediatrica”, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Ghizzi
- AMIETIP ”Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica”, Major Hospital Polyclinic: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Bologna, Italy
| | - Stefania Zampogna
- SIMEUP “Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica”, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Virgilio Paolo Carnielli
- SIMP “Società Italiana di Medicina Perinatale”, University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Favilli
- SICP “Società Italiana di Cardiologia Pediatrica”, University Hospital Meyer, Firenze, Italy
| | - Martino Ruggieri
- grid.8158.40000 0004 1757 1969SINP “Società Italiana di Neurologia Pediatrica”, University of Catania, Catania, Italy
| | - Domenico Perri
- grid.415069.f0000 0004 1808 170XSIPO “Società Italiana Pediatria Ospedaliera”, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Giuseppe Di Mauro
- SIPPS “Società Italiana di Pediatria Preventiva e Sociale”, Local Health Authority Caserta, Caserta, Italy
| | - Guido Castelli Gattinara
- grid.414125.70000 0001 0727 6809SITIP “Società Italiana di Infettivologia Pediatrica”, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Antonio D’Avino
- FIMP “Federazione Italiana Medici Pediatri”, Local Health Authority Naples 1 Centre, Naples, Italy
| | - Paolo Becherucci
- SICuPP “Società Italiana delle Cure Primarie Pediatriche”, Florence City Council, Florence, Italy
| | - Arcangelo Prete
- grid.412311.4AIEOP “Società Italiana di Ematologia e Oncologia Pediatrica”, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giuseppe Zampino
- grid.411075.60000 0004 1760 4193SIMGePeD “Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite”, University Hospital Agostino Gemelli, Rome, Italy
| | - Marcello Lanari
- grid.6292.f0000 0004 1757 1758Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Biban
- grid.411475.20000 0004 1756 948XUniversity Hospital of Verona, Verona, Italy
| | - Paolo Manzoni
- grid.417165.00000 0004 1759 6939Ospedale Degli Infermi, Biella, Italy ,grid.7605.40000 0001 2336 6580University of Turin, Turin, Italy
| | - Susanna Esposito
- grid.10383.390000 0004 1758 0937University of Parma, Parma, Italy
| | - Giovanni Corsello
- grid.10776.370000 0004 1762 5517University of Palermo, Palermo, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy.
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Lin J, Zhang Y, Song A, Ying L, Dai J. Exploring the appropriate dose of nebulized hypertonic saline for bronchiolitis: a dose-response meta-analysis. J Investig Med 2021; 70:46-54. [PMID: 34518319 DOI: 10.1136/jim-2021-001947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/05/2023]
Abstract
Nebulized hypertonic saline (HS) has gathered increasing attention in bronchiolitis. This study aims to evaluate the relationship between the dose of nebulized HS and the effects on bronchiolitis. Five electronic databases-PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ISRCTN-were searched until May 2021. Randomized controlled trials (RCTs) that investigated the effect of HS on bronchiolitis were included. A total of 35 RCTs met the eligibility criteria. HS nebulization may shorten the length of stay (LOS) in hospital (mean difference -0.47, 95% CI -0.71 to -0.23) and improve the 24-hour, 48-hour, and 72-hour Clinical Severe Score (CSS) in children with bronchiolitis. The results showed that there was no significant difference between 3% HS and the higher doses (>3%) of HS in LOS and 24-hour CSS. Although the dose-response meta-analysis found that there may be a linear relationship between different doses and effects, the slope of the linear model changed with different included studies. Besides, HS nebulization could reduce the rate of hospitalization of children with bronchiolitis (risk ratio 0.88, 95% CI 0.78 to 0.98), while the trial sequential analysis indicated the evidence may be insufficient and potentially false positive. This study showed that nebulized HS is an effective and safe therapy for bronchiolitis. More studies are necessary to be conducted to evaluate the effects of different doses of HS on bronchiolitis.
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Affiliation(s)
- Jilei Lin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yin Zhang
- Department of Respiratory and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Anchao Song
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Linyan Ying
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jihong Dai
- Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Hsieh CW, Chen C, Su HC, Chen KH. Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials. BMC Pediatr 2020; 20:434. [PMID: 32928154 PMCID: PMC7489028 DOI: 10.1186/s12887-020-02314-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of treatment with nebulized HS among children with bronchiolitis. METHODS A systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis. RESULTS There were 4186 children from 32 publications included. Compared to the control group, the HS group exhibited significant reduction of severity of respiratory distress, included studies used the Clinical Severity Score (n = 8; MD, - 0.71; 95% CI, - 1.15 to - 0.27; I2 = 73%) and full stop after Respiratory Distress Assessment Instrument (n = 5; MD, - 0.60; 95% CI, - 0.95 to - 0.26; I2 = 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (n = 20; MD, - 0.54; 95% CI, - 0.86 to - 0.23; I2 = 81%). CONCLUSIONS We conclude that nebulization with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigorous randomized controlled trials with large sample size are needed.
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Affiliation(s)
- Chia-Wen Hsieh
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116 Taiwan, Republic of China
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chuan Su
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kee-Hsin Chen
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Angurana SK, Williams V, Takia L. Acute Viral Bronchiolitis: A Narrative Review. J Pediatr Intensive Care 2020; 12:79-86. [PMID: 37082471 PMCID: PMC10113010 DOI: 10.1055/s-0040-1715852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractAcute viral bronchiolitis (AVB) is the leading cause of hospital admissions among infants in developed and developing countries and associated with increased morbidity and cost of treatment. This review was performed to guide the clinicians managing AVB in light of evidence accumulated in the last decade. We searched published English literature in last decade regarding etiology, diagnosis, treatment, and prevention of AVB using PubMed and Cochrane Database of Systematic Reviews. Respiratory syncytial virus is the most common causative agent. The diagnosis is mainly clinical with limited role of diagnostic investigations and chest radiographs are not routinely indicated. The management of AVB remains a challenge, as the role of various interventions is not clear. Supportive care in from of provision of heated and humidified oxygen and maintaining hydration are main interventions. The use of pulse oximetry helps to guide the administration of oxygen. Trials and systematic reviews evaluated various interventions like nebulized adrenaline, bronchodilators and hypertonic saline, corticosteroids, different modes of noninvasive ventilation (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and noninvasive positive pressure ventilation [NPPV]), surfactant, heliox, chest physiotherapy, and antiviral drugs. The interventions which showed some benefits in infants and children with AVB are adrenaline and hypertonic saline nebulization, HFNC, CPAP, NIV, and surfactant. The routine administration of antibiotics, bronchodilators, corticosteroids, steam inhalation, chest physiotherapy, heliox, and antiviral drugs are not recommended.
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Affiliation(s)
- Suresh K. Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vijai Williams
- Pediatric Intensive Care Unit, Gleneagles Global Hospitals, Perumbakkam, Chennai, India
| | - Lalit Takia
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cai Z, Lin Y, Liang J. Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies. Medicine (Baltimore) 2020; 99:e18657. [PMID: 31977855 PMCID: PMC7004745 DOI: 10.1097/md.0000000000018657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX). RESULTS Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36-4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24-15.07]). However, as a selective β2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD -0.11 [95% CI -0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI -0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI -0.35 to 0.75]). CONCLUSION Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.
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Affiliation(s)
| | | | - Jianfeng Liang
- Department of Informatics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
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9
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Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: a blinded non-inferiority randomized controlled trial. BMC Pediatr 2019; 19:417. [PMID: 31699072 PMCID: PMC6839239 DOI: 10.1186/s12887-019-1804-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background The use and optimal duration of treatment with nebulized hypertonic saline (HS) in infants hospitalized for acute bronchiolitis is unclear. The objective was to compare the efficacy of 1 versus 3 days of nebulized 3% HS at 72 h of treatment. We conducted a blinded non-inferiority randomized controlled trial including infants aged less than 12 months old, hospitalized for a moderate bronchiolitis. Methods Nebulisations of 3% HS for 1 day were followed by either the continuation of 3% HS (HS3d group) or switched to 0.9% normal isotonic saline (HS1d group) for 2 days Randomization was performed according to a predefined list with a 1:1 ratio, obtained with a random generator number with blocks.. Main outcome was mean Wang clinical severity score (CSS) after 72 h of treatment. Results One hundred sixteen infants (HS1d n = 59 and HS3d n = 57), were included over two epidemic seasons from 2014 to 2016, but recruitement did not reach the planned sample size. The difference for the Wang CSS score in the HS3d vs HS1d group was 0.71 [IC 90% 0.1; 1.3], above the precluded value of 0.4 set in the protocol defining the non-inferiority of shorter treatment duration. Clinical remission was more rapidly obtained in the HS3d than in HS1d (2.3 ± 1.6 vs 2.9 ± 1.4 days, p = 0.04), with a non-significant tendency for less need of nutritional support and supplemental oxygen in HS3d group. Clinical worsening and treatment intolerance were similar in the 2 groups. Conclusions Despite being underpowered, results seem not to be in favour of reducing the duration of nebulised HS treatment from 3 to 1 day in acute moderate bronchiolitis. Trial registration Clinical trials NCT 02538458, October 2014.
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Abstract
The 2014 American Academy of Pediatrics bronchiolitis guidelines do not adequately serve the needs and clinical realities of front-line clinicians caring for undifferentiated wheezing infants and children. This article describes the clinical challenges of evaluating and managing a heterogeneous disease syndrome presenting as undifferentiated patients to the emergency department. Although the 2014 American Academy of Pediatrics bronchiolitis guidelines and the multiple international guidelines that they closely mirror have made a good faith attempt to provide clinicians with the best evidence-based recommendations possible, they have all failed to address practical, front-line clinical challenges. The therapeutic nihilism of the guidelines and the dissonance between many of the recommendations and frontline realities have had wide-ranging consequences. Nevertheless, newer evidence of therapeutic options is emerging and forecasts hope for more therapeutically optimistic recommendations with the next revision of the guidelines.
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O'Brien S, Borland ML, Cotterell E, Armstrong D, Babl F, Bauert P, Brabyn C, Garside L, Haskell L, Levitt D, McKay N, Neutze J, Schibler A, Sinn K, Spencer J, Stevens H, Thomas D, Zhang M, Oakley E, Dalziel SR. Australasian bronchiolitis guideline. J Paediatr Child Health 2019; 55:42-53. [PMID: 30009459 DOI: 10.1111/jpc.14104] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
Abstract
AIM Bronchiolitis is the most common lower respiratory tract disorder in infants aged less than 12 months, and research has demonstrated that there is substantial variation in practice patterns despite treatment being well defined. In order to align and improve the consistency of the management of bronchiolitis, an evidence-based guideline was developed for the Australasian population. METHODS The guideline development committee included representation from emergency and paediatric specialty medical and nursing personnel in addition to geographical representation across Australia and New Zealand - rural, remote and metropolitan. Formulation of the guideline included identification of population, intervention, comparator, outcomes and time questions and was associated with an extensive literature search from 2000 to 2015. Evidence was summarised and graded using the National Health and Medical Research Council and Grading of Recommendations Assessment, Development and Evaluation methodology, and consensus within the guideline group was sought using nominal group technique principles to formulate the clinical practice recommendations. The guideline was reviewed and endorsed by key paediatric health bodies. RESULTS The guideline consists of a usable clinical interface for bedside functionality supported by evidence summary and tables. The Grading of Recommendations Assessment, Development and Evaluation and National Health and Medical Research Council processes provided a systematic and transparent process to review and assess the literature, resulting in a guideline that is relevant to the management of bronchiolitis in the Australasian setting. CONCLUSION This is the first robust Australasian acute paediatric guideline and provides clear guidance for the management of the vast majority of patients seen in Australasian emergency departments and general paediatric wards with bronchiolitis.
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Affiliation(s)
- Sharon O'Brien
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Meredith L Borland
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Divisions of Paediatric and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Cotterell
- Department of Paediatrics, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - David Armstrong
- Department of Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Franz Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Bauert
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Brabyn
- Emergency Department, Waikato District Health Board, Hamilton, New Zealand
| | - Lydia Garside
- General Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - David Levitt
- University of Queensland, Brisbane, Queensland, Australia
| | - Nicola McKay
- Children's Healthcare Network Western Region, Sydney, New South Wales, Australia
| | | | - Andreas Schibler
- University of Queensland, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Paediatric Critical Care Research Group (PCCRG), Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kam Sinn
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Janine Spencer
- Department of Paediatrics, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Helen Stevens
- Children's Healthcare Network, Sydney, New South Wales, Australia
| | - David Thomas
- General Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael Zhang
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Ed Oakley
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Paediatric Emergency Medicine Centre of Research Excellence, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Youth and Child Health, University of Auckland, Auckland, New Zealand
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12
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Harrison W, Angoulvant F, House S, Gajdos V, Ralston SL. Hypertonic Saline in Bronchiolitis and Type I Error: A Trial Sequential Analysis. Pediatrics 2018; 142:peds.2018-1144. [PMID: 30115731 DOI: 10.1542/peds.2018-1144] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5799873875001PEDS-VA_2018-1144Video Abstract BACKGROUND AND OBJECTIVES: Meta-analyses of nebulized hypertonic saline (HS) for acute viral bronchiolitis have yielded disparate conclusions. Trial sequential analysis (TSA) is a novel method designed to account for potential sources of error in conventional meta-analysis. We sought to use TSA to determine if the existing literature base is sufficient to draw firm conclusions about the effectiveness of HS in bronchiolitis. METHODS We used the cohort of studies identified in previously published conventional meta-analyses. Included studies were those in which authors compared treatment with HS versus normal saline (or supportive care) in children with bronchiolitis to reduce hospital length of stay (LOS) or hospitalizations. TSA results are used to provide a required information size and monitoring boundaries for statistical significance. RESULTS For the LOS outcome, 17 studies including 1866 patients analyzed in which authors used conventional meta-analysis reveal a statistically significant benefit (mean difference = -0.41 days; 95% confidence interval = -0.07 to -0.75); however, TSA suggests that those conclusions are premature because of failure to reach the adequate information size of 2665 individuals. For the risk of hospitalization outcome, 8 studies including 1728 patients analyzed in which authors used conventional meta-analysis reveal a reduction in the relative risk of hospitalization (relative risk = 0.86; 95% confidence interval = 0.76 to 0.98); however, TSA suggests these conclusions are premature because of failure to reach the adequate information size of 4770. Both LOS and hospitalization results from conventional meta-analysis would be considered potentially false-positives by TSA. CONCLUSIONS TSA reveals that concluding benefit from HS for children with bronchiolitis potentially represents type I error.
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Affiliation(s)
- Wade Harrison
- Department of Pediatrics, Primary Children's Hospital and University of Utah, Salt Lake City, Utah
| | - Francois Angoulvant
- Service d'accueil des urgences pédiatriques, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Samantha House
- Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.,Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Vincent Gajdos
- Service de Pédiatrie, Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France; and.,Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Shawn L Ralston
- Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire; .,Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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13
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Zhang L, Mendoza‐Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2017; 12:CD006458. [PMID: 29265171 PMCID: PMC6485976 DOI: 10.1002/14651858.cd006458.pub4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and previously updated in 2010 and 2013. OBJECTIVES To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 11 August 2017. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 8 April 2017. SELECTION CRITERIA We included randomised controlled trials and quasi-randomised controlled trials using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline, or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department trials was rate of hospitalisation. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics. MAIN RESULTS We identified 26 new trials in this update, of which 9 await classification due to insufficient data for eligibility assessment, and 17 trials (N = 3105) met the inclusion criteria. We included a total of 28 trials involving 4195 infants with acute bronchiolitis, of whom 2222 infants received hypertonic saline.Hospitalised infants treated with nebulised hypertonic saline had a statistically significant shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -0.41 days, 95% CI -0.75 to -0.07; P = 0.02, I² = 79%; 17 trials; 1867 infants) (GRADE quality of evidence: low). Infants who received hypertonic saline also had statistically significant lower post-inhalation clinical scores than infants who received 0.9% saline in the first three days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36, P < 0.001; day 2: MD -1.28, 95% CI -1.91 to -0.65, P < 0.001; day 3: MD -1.43, 95% CI -1.82 to -1.04, P < 0.001) (GRADE quality of evidence: low).Nebulised hypertonic saline reduced the risk of hospitalisation by 14% compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; P = 0.02, I² = 7%; 8 trials; 1723 infants) (GRADE quality of evidence: moderate).Twenty-four trials presented safety data: 13 trials (1363 infants, 703 treated with hypertonic saline) did not report any adverse events, and 11 trials (2360 infants, 1265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously. AUTHORS' CONCLUSIONS Nebulised hypertonic saline may modestly reduce length of stay among infants hospitalised with acute bronchiolitis and improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation among outpatients and emergency department patients. However, we assessed the quality of the evidence as low to moderate.
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Affiliation(s)
- Linjie Zhang
- Federal University of Rio GrandeFaculty of MedicineRua Visconde Paranaguá 102CentroRio GrandeRSBrazil96201‐900
| | - Raúl A Mendoza‐Sassi
- Federal University of Rio GrandeFaculty of MedicineRua Visconde Paranaguá 102CentroRio GrandeRSBrazil96201‐900
| | - Claire Wainwright
- Royal Children's HospitalDepartment of Respiratory MedicineHerston RoadHerstonBrisbaneQueenslandAustralia4029
| | - Terry P Klassen
- Manitoba Institute of Child Health513‐715 McDermot AvenueWinnipegMBCanadaR3E 3P4
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14
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Ezzeldin Z, Mansi Y, Gaber M, Zakaria R, Fawzy R, Mohamed MA. Nebulized hypertonic saline to prevent ventilator associated pneumonia in premature infants, a randomized trial. J Matern Fetal Neonatal Med 2017; 31:2947-2952. [DOI: 10.1080/14767058.2017.1359826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Zahra Ezzeldin
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeen Mansi
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mervat Gaber
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Zakaria
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Fawzy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A. Mohamed
- Newborn Services Division, The George Washington University Hospital, Washington, DC, USA
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15
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Pinto JM, Schairer JL, Petrova A. Duration of Hospitalization in Association with Type of Inhalation Therapy Used in the Management of Children with Nonsevere, Acute Bronchiolitis. Pediatr Neonatol 2016; 57:140-4. [PMID: 26464183 DOI: 10.1016/j.pedneo.2015.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/17/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acute bronchiolitis is one of the main respiratory emergencies in young children. Although supportive therapy is recommended, substantial inconsistency in the clinical usage of inhaled treatments has been reported. In the present study, we evaluated the association between different types of nebulized therapies in clinical practice and the length of stay (LOS) of young children hospitalized with nonsevere bronchiolitis. METHODS Medical records of 195 patients with bronchiolitis, without evidence of pneumonia or congenital/chronic respiratory conditions, were stratified with respect to the type of inhalation therapy received: nebulized albuterol (Group 1, n = 53), nebulized albuterol with 3% saline (Group 2, n = 38), nebulized 3% saline alone (Group 3, n = 33), or no inhaled treatment (Group 4, n = 71). Duration of hospital stay was reported with respect to the type of inhalation therapy received after controlling for variability in patient age (months), oxygen saturation, respiratory score, and use of other treatments (antibiotics, oxygen supplementation, and/or corticosteroids). LOS is presented in terms of mean and 95% confidence interval (95% CI). RESULTS The groups were similar except for differences in the mean level of oxygen saturation, respiratory score, and corticosteroid use. Children in Group 4 had the lowest mean respiratory score due to a lesser prevalence of wheezing and/or retractions than in other groups. The LOS for children in Groups 1 and 4 was shorter (43.2 hours, 95% CI 34.9-51.3, and 44.1 hours, 95% CI 37.3-51.0, respectively) than in Groups 2 and 3 (72 hours, 95% CI 62.1-81.6, and 65.1 hours, 95% CI 54.7-75.6, respectively) (p < 0.02). The mean LOS in each group did not change significantly after adjustment for covariants. CONCLUSION Prolonged hospitalization of children younger than 2 years with acute, nonsevere bronchiolitis is associated with administration of nebulized 3% saline, independent of age, clinical presentation of disease, or inclusion of other treatments in their management.
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Affiliation(s)
- Jamie M Pinto
- Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ, USA.
| | - Janet L Schairer
- Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Anna Petrova
- Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ, USA; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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16
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Actualités en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Ravaglia C, Poletti V. Recent advances in the management of acute bronchiolitis. F1000PRIME REPORTS 2014; 6:103. [PMID: 25580257 PMCID: PMC4229723 DOI: 10.12703/p6-103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; it is rarely symptomatic in adults and the most common etiologic agent is respiratory syncytial virus (RSV). Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones (<3 months); however, clinical scoring systems have been proposed and admission in hospital should be arranged in case of severe disease or a very young age or important comorbidities. Apnea is a very important aspect of the management of young infants with bronchiolitis. This review focuses on the clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis.
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Affiliation(s)
- Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic DiseasesGB Pierantoni - L Morgagni Hospital, via C. Forlanini 34, 47100 ForlìItaly
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic DiseasesGB Pierantoni - L Morgagni Hospital, via C. Forlanini 34, 47100 ForlìItaly
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Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med 2014; 22:23. [PMID: 24694087 PMCID: PMC4230018 DOI: 10.1186/1757-7241-22-23] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/28/2014] [Indexed: 12/26/2022] Open
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.
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Affiliation(s)
- Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
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