Bronchiolitis

Question 1

Describe the features that are essential to review in a patient with bronchiolitis.

Answer 1

(1) Wakefulness, (2) Feeding, (3) Hydration status, (4) WOB, (5) Sats, (6) Age, (7) Comorbidities

Question 2

Describe the features of a child with mild bronchiolitis.

Answer 2

(1) Alert, (2) Feeds >50%, (3) Not dehydrated, (4) Minimal WOB, (5) Sats >90%, (6) Age >6 weeks, (7) No major comorbidities/not high risk at baseline

Question 3

Describe the features of a child with moderate bronchiolitis.

Answer 3

(1) Lethargic/tired, (2) Feeds <50% of normal, (3) Dehydrated, (4) Marked WOB, (5) Sats <90%, (6) Age <6 weeks, (7) High-risk patient (ex-prem, cardiac disease etc)

Question 4

Describe the features of a child with severe bronchiolitis.

Answer 4

As per moderate bronchiolitis + escalating oxygen requirement, fatigue, CO2 retention, apnoeas

Question 5

How would you manage a child with mild bronchiolitis?

Answer 5

Discharge home, smaller/frequent feeds. GP review in 24 hours. SOB worsens over 2-3 days.

Admit all children that are borderline or early in disease process.

Question 6

How would you manage a child with moderate bronchiolitis?

Answer 6

Admit, oxygen if sats >94%, minimise handling, NG/IV fluids, close observation

Question 7

How would you manage a child with severe bronchiolitis?

Answer 7

Cardiorespiratory monitoring, consider CPAP/IPPV and PICU

Question 8

Describe the management considerations for bronchiolitis: salbutamol.

Answer 8

No conclusive evidence.
Consider trial if > 8 months, family hx of atopy and recurrent wheeze on exam.

RCH guidelines 2019 state do not give this to infants with a personal/fhx of atopy…

Question 9

Describe the management considerations for bronchiolitis: adrenaline.

Answer 9

No conclusive evidence and should be avoided

Question 10

Describe the management considerations for bronchiolitis: steroids.

Answer 10

No conclusive benefit and so should be avoided

Question 11

Describe the management considerations for bronchiolitis: ipratropium.

Answer 11

No benefit so avoid.

Question 12

Describe the management considerations for bronchiolitis: antibiotics.

Answer 12

No evidence in uncomplicated bronchiolitis. Only if has secondary infection.

Question 13

Describe the management considerations for bronchiolitis: CPAP.

Answer 13

No real evidence but consider in severe bronchiolitis.

Question 14

Describe the management considerations for bronchiolitis: ribavirin.

Answer 14

Marginal benefit in studies and has a limited role in PICU patients.

Question 15

What is ribavirin?

Answer 15

Antiviral medication used to treated RSV infection.

Question 16

List 3 supportive management considerations that have no benefit/inconclusive benefit in bronchiolitis.

Answer 16

No benefit: chest physio, mist/steam, cough suppressants.

Inconclusive: saline drops, suctioning, nebulised hypertonic saline

Question 17

List risk factors for patients to develop severe bronchiolitis.

Answer 17

(1) Chronological age <10 weeks at presentation, (2) Chronic lung/heart/neuro disease, (3) Indigenous, (4) Immunodeficiency, (5) Young maternal age

Question 18

What age group does bronchiolitis typically affect?

Answer 18

<12 months

Question 19

Define bronchiolitis.

Answer 19

Upper respiratory tract infection followed by the onset of respiratory distress, fever and 1+ of the following: cough, tachypnoea, retractions, widespread crackles/wheeze

Question 20

When should high flow nasal prong oxygen be considered in bronchiolitis?

Answer 20

Only heated humidified high flow oxygen/air via nasal cannulae if there is hypoxia (<90%) and a lack of response to standard prongs or where the patient has severe disease.