Bronchiolitis Flashcards
What are ‘wheezes’ and when are they heard?
- musical continuous sounds from narrowed airways
- heard on EXPIRATION (airway obstruction)
What is the age range for Acute Bronchiolitis?
</= 2 years old
What is the pathophysiology of bronchiolitis?
bronchiolar obstruction with edema, mucus, and cellular debris
- dec. airway radius during expiration = expiratory wheezing, air trapping, lung hyperinflation
What happens if airway obstruction becomes complete?
- air reabsorbed and child develops ATELECTASIS
What is hypercapnia?
Increased carbon dioxide levels
PaCO2 > 42 mmHg
What entity is responsible for > 50% of bronchiolitis cases?
RSV
What is the most common diagnosis resulting in hospitalization of children younger than 1 year of age in the United States?
RSV Bronchiolitis
When do Bronchiolitis symptoms typically peak?
Day 4-5 of infection
What are 4 findings that should be asked about in FHx for patients with bronchiolitis?
- Cystic Fibrosis
- Immunodeficiencies
- Asthma (1st degree)
- other lung Dz
What are the current recommendations for chest physiotherapy, corticosteroids, and nebulized albuterol in treating bronchiolitis?
NOT INDICATED
What is the mainstay of treatment for hospitalized bronchiolitis? (3)
- oxygen support (NC, PPV, HFNC, etc) –> wean as tolerated
- maintenance IVFs (poor PO intake) –> IV or NG
- suction (nares or oropharynx)
What is the goal oxygen saturation level for bronchiolitis patients?
> 90%
What is the only marketed drug that targets RSV and is it indicated in standard bronchiolitis treatments?
Drug = Ribavirin
- NOT RECOMMENDED (expensive, hard to administer, minimal disease outcome impact)
What is the median duration of symptoms in ambulatory patients?
14 days
What is the best prophylactic prevention of bronchiolitis?
What option is available for prophylaxis of high-risk patients?
Best = meticulous hand hygiene (Wash those hands)
High-risk = Palivizumab (IM monoclonal Ab to RSV F protein)
Broadly, what patient populations will likely be candidates for Palivizumab prophylaxis? (5)
- premature
- CHD
- CLD
- neuromuscular disease
- immunodeficient
How is RSV spread?
CONTACT-precautions
- spread by aerosols, contact with secretions, and fomites (indirect contact)
How does racemic epinephrine work and is it indicated in the treatment of bronchiolitis?
MOA: activation alpha (vasoconstriction and fluid resorption and beta (bronchodilation)
- NOT ROUTINELY INDICATED –> bronchiolitis caused more by bronchOBSTRUCTION, not bronchoCONSTRICTION
When should oral feeds be trialed in patients receiving HFNC support for bronchiolitis?
- initiate oral nutrition after the FIRST successful wean of HFNC flow rate
What is the mechanism of action of High Flow Nasal Cannula support?
- washout of nasopharyngeal anatomic dead space
- replaces CO2-rich/O2-poor air in nasopharynx at end exhalation with CO2-free/O2-rich gas = improved oxygenation
What is the initial rate of HFNC that should be started for bronchiolitic patients?
1-2L
What is the risk of having asthma/wheezing later in life in children hospitalized for bronchiolitis?
4x higher risk
