Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Bronchiolitis
- Quality Story
- Reducing Albuterol Use in Children with Bronchiolitis
Additional Treatment Considerations
- Albuterol Trial
- Racemic epinephrine
- Antibiotics
- Hypertonic Saline
Consider ED Asthma Pathway if:
- Recurrent wheezing / prior steroid use
- Age > 12 months
- Strong response to albuterol
Mild
Moderate
Severe
Consider Suction-bulb
Suction: Bulb
Bronchodilators not recommended for typical bronchiolitis. If used, document reason and response.
- Suction: Bulb or wall
- 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 HFNC oxygen at 1.5 L/kg/minute – View Job Aid
- See Enteral Feeding Guidelines
- 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
- 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 weeks
- Respiratory rate ≥ 70
- Age < 3 months
Posted: September 2005
Revised: May 2022
Authors: R. Abaya, MD; K. Crescenzo, RN; E. Delgado, MD; M. Dunn, MD; M. Kerrigan RRT; A. Reardon CRNP; N. Strobel CRNP; D. Simpkins RRT; L. Tyler, RRT; J. Zorc, MD
Revised: May 2022
Authors: R. Abaya, MD; K. Crescenzo, RN; E. Delgado, MD; M. Dunn, MD; M. Kerrigan RRT; A. Reardon CRNP; N. Strobel CRNP; D. Simpkins RRT; L. Tyler, RRT; J. Zorc, MD