There are new guidelines from the American Academy of Pediatrics, just in time for the 2014-15 bronchiolitis season looming on the horizon – as if we don’t have enough to worry about with influenza and various West African hemorrhagic fevers.
But, the good news – these guidelines substantially reduce the things you have to remember to do for bronchiolitis. Specifically, the only evidence-supported intervention you have is: supportive care.
Ineffective, or of inadequate risk/benefit, treatments:
- A trial of bronchodilators, such as albuterol or salbutamol.
- Nebulized epinephrine.
- Nebulized hypertonic saline, except possibly those requiring hospitalization.
- Systemic or inhaled corticosteroids.
- Chest physiotherapy.
… which basically covers everything.
And, not inconsistent with a recent trial regarding the misleading clinical weight of pulse oximetry, the guidelines state it is reasonable not to perform continuous oximetry on infants and children with bronchiolitis, and set 90% as an acceptable oxygen saturation. Finally, the authors also state routine chest radiography should be avoided, as abnormalities are common in bronchiolitis – thus leading to ineffective, and harmful, antibiotic administration.
Simply put – do no harm!
“Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis”
http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html