Emergency Department Clinical Pathway for Evaluation/Treatment of Infants with Bronchiolitis
- Related Pathways
- Bronchiolitis, Inpatient
- Quality Story
- Reducing Albuterol Use in Children with Bronchiolitis
- Supportive Care
- Suction
- Hydration, nutrition
- Supplemental oxygen
- Pulse oximetry
- Fever management
- Additional Treatment Considerations
- Albuterol trial
- Racemic epinephrine
- Antibiotics
- Hypertonic saline
- Further Diagnostic Testing
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
- Consider Suction
- NeoSucker or wall suction catheter
- Bronchodilators not recommended for typical bronchiolitis; if used, document reason and response
- If no improvement after suctioning, assess with attending at bedside to discuss additional treatment including initiating High-Flow Nasal Cannula (HFNC) oxygen at 1.5 L/kg/min
- PIV not indicated
- If required FiO2 > 0.4 or continued severe distress despite increase to 2 L/kg/min / Max HFNC settings, initiate CPAP at 8 cm/0.4 FiO2 and consult PICU.
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:
- 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
Evidence
- Reducing Albuterol Use in Children With Bronchiolitis
- Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis
- A Randomized Trial of High-flow Oxygen Therapy in Infants with Bronchiolitis
- Multicenter Quality Collaborative to Reduce Overuse of High-Flow Nasal Cannula in Bronchiolitis
- Quality Improvement to Reduce High-Flow Nasal Cannula Overuse in Children With Bronchiolitis
Educational Media