Bronchiolitis Flashcards
What is bronchiolitis?
Viral LRTI generally affecting children under 12m. Most frequent cause of hospitalisation in children less than 6m. Consider overlap with asthma if 12m+
What are the risk factors for severe bronchiolitis?
- Young (esp less 6w)
- Ex premi
- CHD
- Neurological conditions
- Chronic respiratory illness
- Pulmonary HTN
Describe the time course of bronchiolitis
- Peak severity D2-3
- Illness resolution over 7 - 10d
- Cough may persist for weeks
What are the PEx features of bronchiolitis?
- Increased WOB
- Widespread wheeze and creps
- +/- fever
- +/- dec SaO2
- Assess for dehydration
What are the signs of moderately severe bronchiolitis?
- Irritable
- Inc RR, tracheal tug, nasal flaring
- Mod chest wall retraction
- Reduced feeding
- Mild hypoxemia (90-93%)
- +/- brief apnoeas
What are the signs of severe bronchiolitis?
- Irritability / lethargy / fatigue
- Marked inc or dec in RR
- Marked chest wall retraction
- Reluctant or unable to feed
- Hypoxemia: less 90%
- May have more frequent or prolonged apnoeas
What investigations are required in bronchiolitis?
Most children: NO investigations.
- NPA: not routine
- CXR: not routine unless diagnostic uncertainty / local signs.
- Blood gas: not routinely required
What are the typical features of bronchiolitis on CXR?
- Hyperinflation
- Peribronchial thickening
- Patchy consolidation / collapse
What is the general approach to acute management of bronchiolitis?
Supportive:
- oxygenation
- maintain fluids
- minimal handling
How is mild bronchiolitis managed?
- Home Mx
- Advise parents of expected course, when to return
- Give info leaflet
- Smaller, frequent feeds
- Further Rv if:
- -early
- -RFx present
- -increasing signs of severity develop
How is moderate bronchiolitis managed?
- Discuss with paeds for admission
- O2 maintain 92%+
- Consider limiting fluids to 2/3 maintenance
- 1-2h obs
How is severe bronchiolitis managed?
- Cardioresp monitoring
- Close nursing
- Supplemental O2 and fluids
- Consider tertiary transfer with ICU facilities
When should child be transferred to tertiary centre?
- Severe
- Comorbidities (e.g. premi)
- Apnoeas
- Children needing care above comfort of hospital
- O2 requirement 50%+
Do bronchodilators have a role in bronchiolitis?
Do not alter course of acute bronchiolitis. Some evidence for neb saline but not standard therapy.
Are ABx indicated for bronchiolitis?
Not for uncomplicated bronchiolitis.
What are the CFx of bronchiolitis?
- Cough
- Tachypnoea
- Poor feeding
- Wheeze
- Crackles
- Apnoea
- Mucous production and inflammation causing obstruction at level of bronchioles.
Hx features to elicit in bronchiolitis assessment?
- Age
- Duration (peak 3-5d)
- Hx prematurity
- PMHx
- Recent intake / output
- FHx atopy / asthma
- Apnoea: #, frequency, duration
What must be assessed and documented in PEx for bronchiolitis admission?
- Temperature
- RR
- HR
- BP
- SPO2 and/or Oxygen requirements
- Pain
- Level of Respiratory Distress
- Central and Peripheral
- Capillary Refill Time
- Colour – i.e.: pink, pale, grey, cyanosed, flushed
Feeding / Hydration Status / urine output - Level of consciousness / irritable/ consolable etc
What are the potential indications for NPA in bronchiolitis?
- Hx of apnoeas
- severe or atypical illness
- clinical suspicion of pertussis
Which viruses are most commonly responsible for bronchiolitis?
- RSV
- Human metapneumovirus
What is the only intervention demonstrated to improve the condition of children with bronchiolitis?
Supplemental oxygen.
Mx thus centres around symptomatic relief, hydration and oxygenations.
What are the supportive care management strategies?
- Humidified oxygen
- Hydration maintenance
- Mechanical ventilation
- Nasal and oral suctioning
- Apnoea and cardiorespiratory monitoring
- Temp regulation in small infants
What are bronchioles?
Small airways
What is the bronchiolar lining comprised of?
- surfactant secreting Clara cells
- neuroendocrine cells (somatostatin, endothelin, serotonin)
