Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Bronchiolitis

  • Supportive Care
    • Suction
    • Hydration, nutrition
    • Supplemental oxygen
    • Pulse oximetry
    • Fever management
Consider ED Asthma Pathway if:
  • Recurrent wheezing/prior steroid use
  • Age > 12 mos
  • Strong response to albuterol
Mild
Moderate
Severe
Consider Suction: Bulb

Consider Suction:
Bulb or NeoSucker

Bronchodilators not recommended for typical bronchiolitis; if used, document reason and response

Discharge Criteria
Admission Criteria
  • Oxygen saturation > 90% awake
  • Adequate oral intake
  • Mild/moderate work of breathing
  • Reliable caretaker
  • Able to obtain follow-up care
  • MDI/spacer teaching if response
    to albuterol
  • Observed for 2 hrs if requiring wall catheter suction
  • Base decision on:
    • Repeated assessments
    • Response to therapy
    • Stage of illness
  • Admit if discharge criteria not met:
    • Inpatient: Requires HFNC, O2 or progression expected
    • EDECU: Mild disease with expected LOS < 24 hrs
    • ICU: Apnea, severe distress
      • Requires HFNC above floor maximum, noninvasive or invasive ventilation
  • Infants with these risk factors present early in the illness have higher risk of progression:
    • Gestational age < 34 wks
    • Respiratory rate ≥ 70
    • Age < 3 mos
Posted: September 2005
Revised: November 2023
Editors: Clinical Pathways Team