DynaMed Plus: Bronchiolitis 25/06/2018, 3+43 PM

Bronchiolitis
Overview and Recommendations
Background
Bronchiolitis is a viral respiratory infection (usually respiratory syncytial virus) characterized by an
upper respiratory prodrome followed by wheezing and increased respiratory effort in children < 2
years old.
Most infections occur during wintertime epidemics.

Evaluation
Bronchiolitis typically presents as a respiratory illness with wheezing, fever, tachypnea, retractions,
and increased respiratory effort.
Bronchiolitis is diagnosed clinically and laboratory testing, radiologic studies, and rapid viral
testing are not routinely needed for diagnosis and management (Strong recommendation).
In infants and young children hospitalized with respiratory syncytial virus lower respiratory tract
infection:
consider urinalysis in infants < 90 days old
consider not doing blood cultures routinely
Pulse oximetry may be useful for assessment and monitoring.
Consider pneumonia in children with fever > 39 degrees C (102.2 degrees F).

Management
Assess hydration and the ability to take fluids orally (Strong recommendation).
Use superficial nasal suctioning if necessary.
Supplemental oxygen:
Provide O2 if oxyhemoglobin saturation (SpO2) is persistently < 90% to maintain SpO2 ≥
90%.
O2 is optional if SpO2 is persistently > 90% in previously healthy children (Weak
recommendation).
Consider nasal continuous positive airway pressure to reduce respiratory distress and hypercapnia.
Consider a surfactant in mechanically ventilated infants.
Nebulized hypertonic saline in bronchiolitis patients has not been shown to be effective.
Other bronchodilators, corticosteroids, ribavirin, antibiotics, and chest physiotherapy should not be
used routinely in the management of bronchiolitis (Strong recommendation).

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