Inpatient Pathway for Treatment of
the Child with Bronchiolitis

SUPPORTIVE CARE
Suction
Hydration, nutrition
Supplemental oxygen
Pulse oximetry
Fever Management
Additional Treatment Considerations

Further Diagnostic Testing

Initial Work-up
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