Inpatient Pathway for Treatment of the Child with Bronchiolitis

Additional Treatment Considerations

May be considered in infants with significant respiratory distress that is not alleviated sufficiently by supportive care interventions.

Albuterol Albuterol should NOT be continued if the patient does not respond to test dose.
If responsive to albuterol test dose, may continue:
  MDI Frequency of every 1-4 hours as needed
  Intermittent nebulization Frequency of every 2-6 hours as needed
Perform Intervention Score before and after each treatment
Racemic Epinephrine
  • α and β adrenergic agonist
  • Consider use in patients with increasing severe respiratory distress
  • Requires MD order/bedside assessment for administration
  • Perform Intervention Score before and after each treatment
High Flow Nasal Cannula
  • Provides warmed, humidified air with adjustable oxygen concentration
  • Reduces WOB
  • Use in patients increasing WOB on the escalation pathway.
    • HFNC may be initiated on any inpatient unit for one hour
    • Patients who improve on HFNC may remain on 8S or 7W MHT:
      • if oxygen flow setting is acceptable
      • consult ICU if respiratory status is deteriorating
    • Patients requiring High Flow Nasal Cannula on any other floor must be transferred to ICU
Antibiotics
Hypertonic Saline
  • Regular administration of nebulized hypertonic (3%) saline to inpatients has been shown to shorten length of stay by one day
  • Benefit comes with regular use every 6-8 hours for the entire hospitalization
  • Consider initiating a hypertonic saline regimen (standing every 6-8 hours) in children with a prolonged hospital stay or those not showing improvement over the first 48 hours of admission.