| Albuterol |
Studies have not demonstrated a consistent benefit for albuterol treatment in infants with typical bronchiolitis. An albuterol trial may be considered in children with features suggestive of possible asthma (recurrent wheezing, age > 12 mos, prior inhaled corticosteroid use).
Albuterol should not be continued if the child does not respond to test dose.
| If responsive to albuterol test dose, may continue: |
| |
MDI |
Frequency of every 1-4 hrs as needed |
| |
Intermittent nebulization |
Frequency of every 2-6 hrs as needed |
|
| Racemic Epinephrine |
- α and β adrenergic agonist
- Consider use in infants with increasing severe respiratory distress
- Requires MD order/bedside assessment for administration
|
| HFNC |
- HFNC is indicated to reduce work of breathing in infants with bronchiolitis or other lower respiratory conditions. Evidence of benefit for children > 12 mos is lacking.
- Initiation of HFNC should be based on severe respiratory distress on repeated assessments not resolved with suctioning and supportive care.
- Pausing to reassess has been shown to successfully reduce unnecessary use of HFNC.
- Prior to initiation in ED, Attending assessment required.
- HFNC should be titrated to minimum settings required to relieve work of breathing, usually 1.5-2 L/kg/min with a weight-based maximum.
- HFNC is an expensive and resource-intensive therapy which should be weaned off as soon as possible once infants are improving.
- Enteral feeding is safe and effective for infants receiving HFNC unless worsening with signs of impending respiratory failure.
|
| Antibiotics |
- Do not prescribe antibiotics without evidence of bacterial infection:
- Bacterial superinfections are uncommon in this age group.
- Prescribe antibiotics only when there is a specific secondary infection.
|
| Hypertonic Saline |
- Current research does not support a role for routine use of hypertonic saline in the ED or inpatient unit.
- Consider initiating a hypertonic saline regimen (standing every 6-8 hrs) in children with a prolonged hospital stay or those not showing improvement over the first
48 hrs of admission.
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