bronchiolitis
BRONCHIOLITIS
Bronchiolitis is a clinical diagnosis preceding upper respiratory illness and/or rhinorrhea.
Signs of respiratory illness which may include wheezing, retractions, oxygen desaturation, color change, nasal flaring.
There is also presence of apnea especially in premature or low birthweight infants, signs of dehydration and exposure to persons with viral upper respiratory infections.
Symptoms are usually worst on the 3rd-5th day of illness and then improve gradually.

Supportive Therapy

 Supplemental Oxygen (O2)

  • Adequate oxygenation is achieved at an oxygen saturation (SaO2) between 92-94%
  • Supplemental humidified (O2) should be started when the oxygen saturation (SaO2) is consistently <90%, with signs of hypoxia, increased work of breathing, and/or increased fatigue with feeding
    • May choose not to administer supplemental oxygen (O2) if child's oxygen saturation (SaO2) is >90%
  • Oxygen saturation (SaO2) should be maintained at ≥95% in patients with moderate symptoms of bronchiolitis and >95% in patients with severe symptoms/signs of bronchiolitis
  • Respiratory failure may be imminent when oxygen saturation (SaO2) remains low despite inspired oxygen (O2) level of >40% or when carbon dioxide (CO2) levels are rising
  • Weaning off oxygen (O2) supplementation may be considered when oxygen saturation (SaO2) is consistently >94%
    • Observe for at least 4 hours after cessation of oxygen (O2) supplementation

Non-Invasive Ventilation

  • Considered for patients with progressive breathing difficulties despite pharmacological treatment
  • Continuous positive airway pressure (CPAP) is recommended for acute bronchiolitis patients with severe respiratory difficulties, hypercapnia, or recurrent apnea
  • Mechanical ventilation should be considered if symptoms worsen even with non-invasive ventilation, and signs of possible respiratory arrest is present
  • High frequency oscillatory ventilation (HFOV) may be considered if patient worsens even with mechanical ventilation and pharmacological treatment
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