Inpatient Pathway for Treatment of
the Child with Bronchiolitis
Related Pathway
Bronchiolitis Emergent
Evaluation
Bronchiolitis Emergent
Evaluation
Quality Story
Reducing Albuterol Use in Children with Bronchiolitis
Reducing Albuterol Use in Children with Bronchiolitis
Additional Treatment Considerations
- Albuterol Trial
- Racemic epinephrine
- Antibiotics
- Hypertonic Saline
- Score-Treat-Score
Initial Work-up
- History and Physical
- Bronchodilators not recommended for typical bronchiolitis. If used, document reason and response.
- RT: Baseline Assessment
- Droplet/Contact Precautions
- Determine symptom severity
Severe
Moderate
Mild
- 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
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
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
Revised: January 2016, February 2016, October 2017, March 2018, June 2018, November 2019, December 2019
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