Inpatient Clinical Pathway for Evaluation/Treatment
of Children with Bronchiolitis

Goals and Metrics
Patient Education
Provider Resources
SUPPORTIVE CARE
Suction
Hydration, nutrition
Supplemental oxygen
Pulse oximetry
Fever Management
Child with Bronchiolitis
Additional Treatment Considerations

Further Diagnostic Testing

Initial Work-up
Severe
Mild
Moderate
  • Q 1h assessments
  • Nasal suctioning - Wall
  • Continuous O2 monitoring
  • CR Monitoring
  • IV fluids/NG tube feeds/PO as tolerated
  • Use of HFNC automatically classifies patient as Severe
  • High flow nasal cannula (HFNC) Use:
    • Initiate if severe distress/hypoxemia despite supportive care at 1.5 L/kg/min
    • Titrate to max settings using HFNC Job Aid.
    • Remain in Severe pathway while on HFNC
    • Assess mild/moderate/severe based on status
  • Weaning
    • If mild/moderate x 4 hours, decrease to 1 L/kg/min x 2 hours, then discontinue if remains moderate/mild
  • Q 2h assessments
  • Nasal suctioning – Bulb/Wall
  • Intermittent O2 monitoring
  • IV fluids/NG tube feeds/PO
    as tolerated
  • Q 4h assessments
  • Nasal suctioning – Bulb
  • Intermittent O2 monitoring
  • Resume normal feeds
ESCALATION
  • Consider:
  • Racemic epinephrine
  • CAT Call
  • Make child NPO
Discharge Criteria

Response to Intervention Score

    Mild (0) Moderate (1) Severe (2)
RR < 3 months 30-60 61-80 > 80
3 - < 12 months 25-50 51-70 > 70
1 years - 2 years 20-40 41-60 > 60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Posted: November 2013
Revised: January 2016, February 2016, October 2017, March 2018, June 2018, November 2019, December 2019,
October 2021
Authors: M. Dunn, MD; J. Zorc, MD; J. Kreindler, MD; L. Tyler, RRT; E. Pete Devon, MD; M. McCloskey, RN;
V. Madrigal, MD; L. McAndrew, MD; A. Barnes, MD; A. Gahman, RN; K. Leach, RN, R. Keren, MD